“Suspension bridge” external fixation technique for the treatment of proximal humeral fractures

Abstract

Background: The purpose of this study was to investigate the clinical efficacy of the ''suspension bridge'' external fixation technique for the treatment of proximal humeral fractures with or without soft tissue defects and infection, as well as postoperative revision. Methods: From August 2013 to June 2018, 9 patients with proximal humeral fractures were selected. There were 5 males and 4 females, with an average age of 55.2 years (range: 32-74 years). Five patients were diagnosed with acute fractures (soft tissue defects in 2 patients). Of these patients, 1 patient was diagnosed with a fracture of the anatomic neck, 2 patients with 3-part fractures, and 2 patients with 4-part fractures. Internal fixation failure occurred in 4 patients, who needed revision surgery. Of these 4 patients, 1 patient was diagnosed with an anatomic neck fracture and 3 patients with 4-part fractures before surgery. Postoperative plate and screw fixation failure was the main cause of revision. One patient had an accompanying skin defect, and 1 had an infection. The ''suspension bridge'' external fixation technique was used to treat the fractures in the revision surgeries. Results: The operative time was 84.1 minutes (range: 63-120 minutes), and the blood loss was 224.4 mL (range: 140-320 mL). The follow-up period was 35.1 months (range: 16-72 months). All fractures unioned, with an average unioning time of 12.7 weeks (range: 8-16 weeks). At the final follow-up, the flexion was 131.8 (range 108 -152 ), extension 39.9 (range 32 -47 ), abduction 128.6 (range 110 -150 ), internal rotation 43.9 (range 34 -55 ), and external rotation 60.7 (range 46 -72 ); the mean visual analog scale score for pain was 1.3 (range 0-3), and the mean Neer score was 87.4 points (range 75-98 points). Efficacy was assessed as excellent in 4 patients, good in 3 patients, and acceptable in 2 patients; the excellent or good rate was 77.8%. No adverse events, such as postoperative infection, fixation failure, and nonunion, occurred during the follow-up. Conclusion:The ''suspension bridge'' external fixation technique is an effective method for the treatment of proximal humerus fractures, and it can also be used for the treatment of skin defects and infections.

What’s New in Limb Lengthening and Deformity Correction

“…A limited report from Tunisia of 58 humeral pseudarthroses showed that effective union was achieved with a no-touch compression technique via monolateral external fixation 52 . Zhao et al reported on 9 cases of a suspension-bridge circular fixator construct for proximal humeral nonunions with skin defects, involving a single diaphyseal ring and multiple oblique olive wires for the fixation of 2, 3, or 4-part fractures 53 . Fifty-four humeral lengthenings were reported by Arenas-Miquelez et al, describing monolateral frame use, proximal-third corticotomies, and a mean lengthening of 9 cm with high satisfaction but 3 patients with resultant elbow flexion contractures 54 .…”

Does minimally invasive external fixation of proximal humerus fractures provide adequate biomechanical stability?

“…With semi-rigid implants like the Humerus-Block [6-9], Humerus-Block NG [10] and Button-Fix [11] (all DePuy Synthes, Solothurn, CH), an attempt was made to overcome over-stiffening of the fracture xation. Several studies have described the use of external xation as a semi-rigid, minimally invasive alternative for proximal humerus fracture xation using a variety of systems and surgical techniques [12][13][14][15]. However, the extent to which these techniques can provide a standardized, safe, and reliable solution for the xation of proximal humerus fractures remains unclear.…”