8/9/2023 0 Comments Humeral neck fractureConsidering the surgical nature of this work, we hypothesized that hanging down the arm in a collar and cuff (as applied in current clinical practice) would not re-align these three fracture patterns. recently classified surgical neck fractures into three categories: type A, B and C (Table 1, Fig. A French study conducted by Boileau et al. However, it remained unclear if the collar and cuff treatment would improve angulation and shaft translation in fractures with ≥ 1 cm of displacement. One study revealed that radiographic angulation on lateral views after 1 week could predict outcomes in minimally displaced proximal humerus fractures. To date, few studies have evaluated radiographic outcomes in non-surgically treated proximal humerus fractures. However, re-alignment may not occur in each type of fracture and if it fails, surgical management can be required to avoid mal- or non-union.īesides biomechanical forces (e.g., muscles and bone-on-bone friction) when wearing a collar and cuff, there may be a relationship between fracture pattern and alignment. In this position, while holding the body upright, traction is generated due to gravity, allowing the shaft to realign with the proximal humerus. If non-operative treatment is chosen, patients are advised to wear a collar and cuff with their arm in internal rotation and the humeral shaft in line with the humeral head. In displaced surgical neck fractures of the humerus, it is not well understood which fracture patterns would respond best to non-operative treatment and which ones would require surgical fixation. Therefore, it is advised that surgical decision-making should be performed immediately after trauma. ConclusionsĪpart from humeral head angulation improvement in type A, there is no increase nor reduction in displacement among the three fracture patterns. Mean NSA of type A fractures improved significantly from 161° at trauma to 152° at last follow-up ( p-value = 0.004). Linear mixed modelling on both MMG and MLG revealed no improvement during follow-up among the three groups. The mean age (range) was 68 years (24–93), and the mean number (range) of follow-up radiographs per patient was 1 (1–4). Sixty-seven patients were included: 25 type A, 11 type B, and 31 type C fractures. Linear mixed modelling was performed to evaluate if these measurements would improve over time. On each radiograph, the maximal medial gap (MMG), maximal lateral gap (MLG), and neck-shaft angle (NSA) were measured. The first radiograph had to be obtained within 24 h after the initial injury and the follow-up radiograph(s) 1 week after trauma and before the start of radiographically visible callus. Patients were included if they sustained a Boileau-type fracture and underwent initial non-operative treatment. Materials and MethodsĪ consecutive series of patients (≥ 18 years old) were retrospectively evaluated from a level 1 trauma center in Australia (inclusion period: 2016–2020) and a level 2 trauma center in the Netherlands (inclusion period: 2004 to 2018). Therefore, this study evaluated if the neckshaft angle and extent of displacement would improve between trauma and onset of radiographically visible callus in non-operatively treated surgical neck fractures (Boileau type A, B, C). It is unclear if the collar and cuff treatment improve alignment in displaced surgical neck fractures of the proximal humerus.
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