肱骨近端NeerIV型骨折lates.pptVIP

Conclusions ORIF of proximal humeral three or four-part fracture yields good functional result in most. Fracture-dislocation associates with a high risk for avascular necrosis. Even that, it did not preclude a good result. Primary Hemiarthroplasty for Treatment of Proximal Humeral Fractures C. Michael Robinson et al J. Bone Joint Surg. Am. 85: 1215-1223,2003 Methods: All patients had normal shoulder function prior to the injury From Jan. 1998 to Dec. 2000, total 138 patients 112/138 four-part fractures Outcome Measures Constant score assessed one year later Muscle power Functional result X-ray ( AP and modified lateral view ): Prosthetic survival to revision Results The average duration of follow-up: 6.3 years The overall prosthetic survival rate One year : 96.9% Five years : 95.3% Ten years : 93.9% Functional Results Conclusions Pain free usually Overall functional results ( ROM. M.P. , function ) were disappointing When the humeral head can be reconstructed, ORIF is recommended If the humeral head is devoid of soft-tissue attachments or unreconstructable, hemiarthroplasty can be performed in medically fit, cooperative patients Hemiarthroplasty as a late reconstructive procedure after initial treatment failed Supplemented with Calcium Phosphate CementBiomechanical Evaluation of Proximal Humeral Fracture Fixation Brian K. Kwon et al J. Bone Joint Surg. Am. 84:951-961, 2002. Methods: ~Cadaveric three-part proximal humeral osteotomy model ~Three types of devices: cloverleaf plate, an angled blade-plate, and Kirschner wires ~The effect of supplementing with SRS (Skeletal Repair System) calcium phosphate cement was evaluated. 肱骨近端 Neer IV 型骨折：切腹內固定 vs 關節置換 Proximal Humeral Fracture: Incidence and Mechanism Proximal humerus fracture: account for 4-5 % of all fractures Incidence: Female male Increases with age; especially after age 50 Cause by direct or indirect forces Vascular Anat