A Modern View on the Surgical Treatment of Proximal Humerus Fractures (Literature Review)

According to the WHO, fractures of the surgical neck of the humerus account for approximately 5-15% of all injuries of the human skeleton bones, moreover in 60% of cases they are characterized by multi-fragmented fractures and are accompanied by a pronounced displacement of the fragments, which contribute to special difficulties in choosing the tactics of surgical treatment or reposition of bone fragments with conservative treatment The severity of displacement of bone fragments depends on the energy strength of the injury, which in 85% of cases is characterized by the absence of displacement of bone fragments due to low-energy injuries, in which surgical intervention is not required, and they are treated conservatively. However, a correct assessment when developing indications for conservative treatment allows achieving good functional results in 80-87% of cases [2,3]. Difficulties in reposition of bone fragments according to AA Kolomiyets et al. (2006) up to 50% of cases are caused by interposition of soft tissues between fragments that prevent closed reposition [4,5]. Despite the high achievement in the surgical treatment of fractures of the surgical neck of the humerus according to E. Weber et al. (1998) complete restoration of damaged limb function was noted only in 38% of cases [5,6]. Most authors believe that conservative treatment should not be abandoned, while others consider it to be ineffective. In general, the result of treatment depends on the severity of the injury, the type of fracture, the quality of the reposition, and also to a large extent on the patient's persistence and level of motivation. The best results are observed in active patients with a high level of self-discipline [3, 7]. The domestic literature describes more than 30 different methods of surgical treatment of fractures of the surgical neck of the humerus. Most often authors use: osteosynthesis of external fixation devices of various design, fixation of bone fragments with transossal sutures, osteosynthesis with pins, plates and screws , intramedullary osteosynthesis (with blocking and using rigid constructions of the "TEN-pin" type), as well as the establishment of a unipolar endoprosthesis of the shoulder joint in cases of severe destruction of the proximal humerus [7,8]. Handoll H.H. et al (2015) divided the surgical methods of treatment for fractures of the proximal humerus into the following:

Ҳали таржима қилинмаган