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      Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model—a retrospective study

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          Abstract

          Background

          To explore the clinical efficacy of 3D printing fracture models to assist in creating pre-contoured plates to treat proximal third humeral shaft fractures.

          Methods

          We retrospectively identified proximal third humeral shaft fractures treated between February 2012 and February 2015. The patients were divided into two groups according to the treatment procedure: a Synbone group and a 3D-printed group. In the Synbone group, long proximal humeral internal locking system plates were pre-contoured into helical shape on Synbones before surgery, while in the 3D-printed group, they were contoured on 3D-printed bone models. The pre-contoured plates were sterilized before surgery and were then used for fracture fixation during surgery. Duration of surgeries, blood loss volumes, the incidence of complications, and the time to fracture union were recorded, and functional outcomes were assessed by the Constant-Murley shoulder score and the Mayo Elbow Performance Score (MEPS) at 1-year follow-up.

          Results

          The subjects comprised 46 patients; 25 patients were allocated to the Synbone group and the remaining 21 to the 3D-printed group. There was no significant difference between the baseline characteristics of the two groups. At the 1-year follow-up visit, all fractures were healed and showed a satisfactory outcome. There were no instances of iatrogenic radial nerve injury, and there was no significant difference between the two groups with regard to fracture union time, Constant-Murley score, or MEPS score. Surgery duration was significantly shorter in the 3D-printed group compared to the Synbone group (42.62 vs. 60.36 min, P = 0.001), and the 3D-printed group lost less blood during surgery (105.19 vs. 120.80 ml, P = 0.001). In addition, in the 3D-printed group, 9 surgeries were finished by senior attending doctors and 12 were finished by junior attending doctors; however, there was no significant difference between the 1-year outcomes of the two grades of surgeons.

          Conclusions

          Our results show that the 3D printing technique is helpful in shortening the duration of surgery, reducing blood loss volume, and in making this surgical procedure easier for less-experienced surgeons.

          Trial registration

          This clinical study was registered in CHICTR on September 30, 2017 (number 17012852).

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          Most cited references22

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          Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

          The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research.
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            Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial.

            We randomised prospectively 44 patients with fractures of the shaft of the humerus to open reduction and internal fixation by either an intramedullary nail (IMN) or a dynamic compression plate (DCP). Patients were followed up for a minimum of six months. There were no significant differences in the function of the shoulder and elbow, as determined by the American Shoulder and Elbow Surgeons' score, the visual analogue pain score, range of movement, or the time taken to return to normal activity. There was a single case of shoulder impingement in the DCP group and six in the IMN group. Of these six, five occurred after antegrade insertion of an IMN. In the DCP group three patients developed complications, compared with 13 in the IMN group. We had to perform secondary surgery on seven patients in the IMN group, but on only one in the DCP group (p = 0.016). Our findings suggest that open reduction and internal fixation with a DCP remains the best treatment for unstable fractures of the shaft of the humerus. Fixation by IMN may be indicated for specific situations, but is technically more demanding and has a higher rate of complications.
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              Outcome after closed functional treatment of humeral shaft fractures.

              The aim of this study was to investigate the outcome after an isolated humeral shaft fracture treated primarily nonoperatively with a fracture brace. University hospital. Descriptive study. Retrospective assessment of clinical and radiographic healing. Prospective assessment of functional outcome and health-related quality of life (HRQoL). Seventy-eight patients (female, n = 45), mean age 58 (range, 16-91) years with isolated humeral shaft fractures. Closed functional treatment with a fracture brace. Fracture healing, need for revision surgery, Short Musculoskeletal Functional Assessment (SMFA), HRQoL according to the Short Form 36 (SF-36) and patient-reported recovery. Ninety percent of the fractures healed after nonoperative treatment, and nearly 90% of the nonunions healed after revision surgery. There was a trend toward more frequent nonunions in simple fractures, that is, type A according to the Orthopedic Trauma Association (OTA) classification (P = 0.08). The nonunion rate in type A fractures located in the proximal and middle part of the shaft was approximately 20%. Nearly 50% of the patients reported full recovery after successful nonoperative treatment, but none of the patients with a healed nonunion did after revision surgery (P < 0.05). The SMFA scores for arm/hand function were acceptable for the patients who healed after the primary fracture-brace treatment, but the values were worse for those with a healed nonunion after revision surgery. The SF-36 scores were generally slightly lower compared with a Swedish reference population. This study confirms the high overall rate of union of humeral shaft fractures and an acceptable functional outcome after successful fracture-brace treatment. However, in simple (type A) fractures, the nonunion rate seems to be higher, and patients with healed nonunions after revision surgery reported worse functional outcomes. Based on these findings, it seems reasonable to explore the use of plate fixation compared with nonoperative treatment for selected fracture types in a randomized controlled trial.
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                Author and article information

                Contributors
                qiukewang@sina.com
                784651104@qq.com
                Junjie.Guan@sina.com
                drchenyunfeng@sina.com
                wanglei2264@126.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                17 August 2018
                17 August 2018
                2018
                : 13
                : 203
                Affiliations
                [1 ]ISNI 0000 0004 1798 5117, GRID grid.412528.8, Department of Orthopedic Surgery, , Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, ; 600 Yishan Road, Shanghai, 200233 People’s Republic of China
                [2 ]Department of Pathology, Shanghai Eighth People’s Hospital, 8 Caobao Road, Shanghai, 200233 People’s Republic of China
                Article
                908
                10.1186/s13018-018-0908-9
                6098615
                30119637
                a0754c57-6204-4c10-ad22-9a6ad87c49ca
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 February 2018
                : 7 August 2018
                Funding
                Funded by: Medical-engineering cross foundation of Shanghai Jiao Tong University
                Award ID: YG2016MS18
                Award Recipient :
                Funded by: Three-year Project for Enhancing Clinical and Innovative Competence of Municipal Hospitals
                Award ID: 16CR3042A
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Surgery
                helical plate,humeral fracture,3d-printed,mipo
                Surgery
                helical plate, humeral fracture, 3d-printed, mipo

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