PMC9720443_01
Female, 72 years old with Neer 3-part valgus fracture of proximal humerus. a. Anterior-posterior X-ray. b. CT three-dimensional reconstruction image. c. Sagittal CT image.
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Radiographs and urgent computed tomography (CT) demonstrated a 3-part valgus PHF (OTA/AO 11-C1) with substantial humeral head displacement and the humeral shaft impacted into humeral head (Fig. 2).
Intraoperative fluoroscopy during surgical fixation procedure using Endosteal Anatomical Support System (EASS) a. Anterior-posterior view of shoulder joint shows Neer 3-part valgus impacted fracture of proximal humerus. b-c. Laminar spreader is inserted to help to restore the humeral head height and glenohumeral joint. d. Insert the nail into the medullary cavity of the humeral shaft at a suitable depth. e. Using periosteal elevator to reset the humeral head. f-g. inserting the guide wire to the center of the humeral head in anterior-posterior and axillary view. h-i. After the operation, the new EASS was used to fix the proximal humerus.
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By opening the lamina spreader, the humeral head is raised to realign with the tuberosities, and the shape of the proximal humerus is restored (Fig. 3a-c). Subsequently, the distal end of the endosteal support nail is inserted into the intramedullary cavity of the humeral shaft to an appropriate depth (Fig. 3d). Using an elevator, we reduce the humeral head position, creating space for the proximal end of the endosteal support nail to enter the medullary cavity (Fig. 3e). Once the entire endosteal nail is inside the humerus, we use aiming tools to adjust the position of the proximal end of the endosteal support nail into directly supporting the humeral head and aligning the humeral head and shaft while monitoring real-time fluoroscopy of anterior-posterior and axillary view (Fig. 3f-g). Using 4 3.5 mm locking screw through small plate to fix tuberosity and then using a 3.5 mm screw to fix small plate to the humeral shaft (Fig. 3h-i).
Radiation and three-dimensional CT at the 3 months follow-up confirmed that fracture healed and EASS position was reliable. a.b. Fracture healed, with neck-shaft angle of proximal humerus 137 degrees, no signs of AVN. c.d. Sagittal and coronal CT view of proximal humerus showed that bone trabecula pass through the fracture site, with direct support of the humeral head from the flat plane construct of the proximal end of the endosteal support nail and of greater tuberosity from support block.
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Bone healing at 3 months postoperatively was confirmed by X-ray and 3-dimensional computer tomography reconstruction (Fig. 4) and the patient's shoulder function was evaluated using Constant Murley score (Table 1).
At 2-year follow-up, the patient was able to perform all activities of daily living and participate in recreational activities. There was excellent pain control and no sign of instability or any complications with the implant. a. X-ray film; b. Function of active elevation.
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There was excellent pain control and no sign of instability or any complications with the implant (Fig. 5).