Influence of preoperative simulation on the reduction quality and clinical outcomes of open reduction and internal fixation for complex proximal humerus fractures

Abstract

Purpose Proximal humerus fractures (PHFs) are common. With the development of locking plates, open reduction and internal fixation (ORIF) of the proximal humerus can provide excellent clinical outcomes. The quality of fracture reduction is crucial in the locking plate fixation of proximal humeral fractures. The purpose of this study was to determine the impact of 3-dimensional (3D) printing technology and computer virtual technology assisted preoperative simulation on the reduction quality and clinical outcomes of 3-part and 4-part proximal humeral fractures. Method A retrospective comparative analysis of 3-part and 4-part PHFs undergoing open reduction internal fixation was performed. Patients were divided into 2 groups according to whether computer virtual technology and 3D printed technology were used for preoperative simulation: the simulation group and the conventional group. Operative time, intraoperative bleeding, hospital stay, quality of fracture reduction, Constant scores, American Society for Shoulder and Elbow Surgery (ASES) scores, shoulder range of motion, complications, and revision surgeries were assessed. Results This study included 67 patients (58.3%) in the conventional group and 48 patients (41.7%) in the simulation group. The patient demographics and fracture characteristics were comparable in these groups. Compared with the conventional group, the simulation group had shorter operation time and less intraoperative bleeding (P < 0.001, both). Immediate postoperative assessment of fracture reduction showed a higher incidence of greater tuberosity cranialization of < 5 mm, neck-shaft angle of 120° to 150°, and head shaft displacement of < 5 mm in the simulation group. The incidence of good reduction was 2.6 times higher in the simulation group than in the conventional group (95% CI, 1.2–5.8). At the final follow-up, the chance of forward flexion > 120° (OR 5.8, 95% CI 1.8–18.0) and mean constant score of > 65 (OR 3.4, 95% CI 1.5–7.4) was higher in the simulation group than the conventional group, as well as a lower incidence of complications in the simulation group was obtained (OR 0.2, 95% CI 0.1–0.6). Conclusions This study identified that preoperative simulation assisted by computer virtual technology and 3D printed technology can improve reduction quality and clinical outcomes in treatment of 3-part and 4-part PHFs.

3D printing assisted MIPO for treatment of complex middle-proximal humeral shaft fractures

“…Wang and colleagues [ 22 ] showed that pre-contouring plates with the assistance of 3D printing technology accurately fit the humeral shape, resulting in an average Constant score of 76.8 at the 12-month follow-up. Wu et al [ 23 ] conducted a retrospective study on the treatment of PHFs. They divided patients into two groups based on whether 3D printing technology was used for preoperative simulation, and found that the simulation group had shorter operation times and less intraoperative bleeding.…”

Analysis of the associated factors in postoperative wound infection following open reduction and internal fixation for elbow fracture

“…The main goal of ORIF in elbow fractures is to re-align and stabilise the joint, which is crucial for enabling early mobilisation and fostering optimal functional recovery. 3,4 This surgical approach is instrumental in facilitating the healing process by ensuring proper alignment of bone fragments and securing them, which is essential for early joint movement and reducing risks such as joint stiffness and muscle atrophy. While ORIF is a critical surgical intervention for elbow fractures, aimed at restoring normal anatomy and ensuring joint stability for optimal functional recovery, this technique is not without its challenges.…”

“…Open reduction and internal fixation (ORIF) have emerged as a pivotal surgical technique for these injuries, focusing on restoring the elbow joint's normal anatomy and ensuring its stability. The main goal of ORIF in elbow fractures is to re‐align and stabilise the joint, which is crucial for enabling early mobilisation and fostering optimal functional recovery 3,4 . This surgical approach is instrumental in facilitating the healing process by ensuring proper alignment of bone fragments and securing them, which is essential for early joint movement and reducing risks such as joint stiffness and muscle atrophy.…”