Assessment of using thread joysticks results for fragment reduction and bone allografting in the treatment of bone defects in patients with proximal humeral fractures

Introduction Despite significant advances in the development of new fixation systems and improvements in surgical technologies, algorithms that guarantee anatomical reduction in proximal humerus fractures are lacking. The aim of this study was to evaluate the clinical efficacy of using thread joysticks for fragment reduction and allogeneic bone grafting materials to repair bone defects in patients with proximal humerus fractures. Material and methods A total of 219 patients with proximal humerus fractures were treated. The main group consisted of 123 patients and was treated according to the proposed by us osteosynthesis, while the comparison group included 96 patients was managed with traditional methods. Long-term outcomes were assessed at 1 to 4 years postoperatively using the Constant score, as well as two questionnaires: the Simple Shoulder Test (SST) and the Oxford Shoulder Score (OSS). Results In the main group, the Constant score ranged from a maximum of 98 to a minimum of 6, with a mean of 69.8 and a median of 73. In the control group, the maximum score was 93, the minimum was 8, with a mean and median of 54. Poor results were observed in 9 patients (7.3 %) in the main group. Of these, 4 (3.3 %) were due to infection, 3 (2.4 %) to implant migration, and 2 (1.6 %) to poor compliance with rehabilitation, leading to shoulder joint contracture. In the comparison group, 32 patients (33.3 %) had poor outcomes. Among them, 15 (15.6 %) had persistent limitations in abduction and internal rotation, 10 (10.4 %) exhibited implant migration, 5 (5.2 %) developed infection requiring reoperation, and 2 (2.1 %) experienced severe post‑traumatic arthritis and humeral head collapse. Discussion The described technique has a number of advantages compared toexisting methods, which allows for stable fixation in cases of 3- and 4-part fractures and avoids the need for shoulder joint replacement. It features a clearly defined algorithm of procedures that simplifies the reduction and fixation of bone fragments, especially in defects of the proximal humerus. Conclusion The application of this surgical technique reduced operative time and improved treatment outcomes in fractures of the proximal humerus.