Anterior shoulder instability （ASI） is a common disease in sports medicine， mainly in young people and athletes， and is usually caused by external forces encountered when the arm is in an extreme abduction and rotation position. The incidence of ASI is 23.9 cases per 100 000 people per year， accounting for 95% of all shoulder dislocations. Due to the contact and compression of the anterior humeral head with the subscapular anterior inferior margin， this injury is usually accompanied by anterior glenolabial and soft tissue injury and posterolateral depression of the humeral head. Hill-Sachs injury occurs in about 67% to 69% of patients in the first dislocation. Hill-Sachs defects increase the risk of laboplasty failure and make patients more prone to re-dislocation，which further leads to structural damage and dysfunction of the glenohumeral joint. In recent years，research has shown that for the first time， dislocation after arthroscopic surgery treatment can significantly reduce the recurrence rate and increase the chances of recovery movement under the arthroscope Bankart repair （arthroscopic Bankart repair， AB）， used to be the gold standard for patients with anterior and inferior labrum tears， Hill-Sachs injuries accounting for less than 20% of the humerus head and no critical bone defect in the anterior pelvis， but studies have shown a high recurrence rate after surgery. Remplissage was first proposed by Conolly et al.， which mainly filled the subincaudal tendon and joint capsule to the Hill-Sachs injury site of the humerus head. Studies have shown that arthroscopic Bankart repair with Remplissage （ABR） combined with AB may reduce the recurrence rate of patients with Hill-Sachs injury， but the benefits of its treatment are still controversial. Surgery such as Remplissage may increase the loss of external rotation Angle after surgery. Meta-analysis can systematically integrate and quantitatively analyze the results of multiple independent studies， improve the statistical efficiency of the study， reduce the contingency and bias of the results of a single study，and help draw more reliable conclusions. Although the efficacy of AB and ABR has been investigated in different studies， results have been inconsistent due to differences in study design， sample size，and outcome measures. Due to the differences in design， outcome indicators， and other aspects of existing studies， meta-analysis helps provide a more accurate and objective effect assessment for AB and ABR treatment of Hill-Sachs injury. It provides more robust evidence to support clinical decisionmaking.
Objective
To evaluate the clinical efficacy of AB combined with ABR in the treatment of shoulder joint forward instability ASI with Hill-Sachs injury by meta-analysis.
Methods
PubMed，Scopus， Embase， Cochrane Library， and Web of Science databases were searched to collect randomized controlled trials， case-control studies， and cohort studies related to AB and ABR treatment of ASI with Hill-Sachs injury. Stata 17.0 was used for statistical analysis.
Results
A total of 18 studies were included， involving 1，515 patients. Compared with AB group， ABR group had significantly lower recurrence rate （OR=0.19， 95% CI：0.12-0.32， P＜0.001）， secondary surgery rate （OR=0.16， 95% CI： 0.07-0.38， P＜0.001）， and complication rate （OR=0.07， 95% CI：0.01-0.49， P=0.007）， and the recovery of motion was better （OR=4.96， 95% CI：1.75-14.03， P=0.003）. However， the two groups had no statistically significant differences in lateral rotation Angle （MD=-6.99， 95% CI： -15.64-1.66， P=0.113）and joint function scores. Sensitivity analysis and publication bias evaluation showed that the results were robust.
Conclusion
ABR was superior to AB in reducing the recurrence rate， secondary operation rate， and complication rate of shoulder forward instability with Hill-Sachs injury， but the difference in postoperative functional recovery was insignificant.
The elbow joint is one of the important joints in the human body， located in the middle of the upper limb， coordinating the activities and functions of the shoulder and wrist joints.Currently， with the rapid development of society and the increase of injuries such as traffic accidents， elbow joint injuries are gradually increasing. Post-traumatic fractures of elbow joints are often accompanied by articular surface fractures and incredibly complex intercondylar fractures of the humerus. This kind of fracture is often comminuted， and the preferred treatment for this disease is surgical treatment. Through surgical open reduction and internal fixation， and early postoperative functional exercise， ideal results can be achieved， and the incidence of complications can be reduced. The main surgical approaches were the olecranon osteotomy approach and the triceps lingual flap approach. Currently， the primary surgical approach for type C2 and C3 intercondylar fractures of the humerus is the transolecranon osteotomy approach. The most significant advantage of this approach has been generally accepted， but there are also literature reports with postoperative disadvantages. It is believed that the cross-section diameter of the olecranon itself is small， and after simple osteotomy reduction and fixation， the postoperative reduction and fixation are prone to be unstable due to the thin structure of the osteotomy. The nonunion of fractures in any part of the elbow joint will affect the range of motion of the elbow joint， and it is easy to produce elbow stiffness after surgery. We need to consider how to avoid the occurrence of bone nonunion at the osteotomy， improve the stability of the osteotomy， and start rehabilitation exercises in advance when preparing for surgery and drawing up the surgical plan. Its essence is how to fix the osteotomy of the olecranon better. There are few fixation methods at the olecranon osteotomy， and the main fixation methods are Kirschner wire tension band internal fixation and steel plate internal fixation， and both methods can be used for early postoperative elbow joint function recovery exercise.
Objective
To investigate the risk of postoperative elbow stiffness in intercondylar fracture of the humerus and olecranon osteotomy with different internal fixation methods.
Methods
Forty patients with intercondylar fracture of the humerus admitted to our hospital from January 2012 to January 2024 were selected and divided into the control group （n=18） and the study group （n=22）. The fixation methods of olecranon osteotomy were plate fixation and wire fixation with Kirschner wire and tension band， respectively.The surgical situation， postoperative fracture healing time， complications and pain visual analogue scale（VAS） score， Mayo elbow function score， elbow motion， postoperative infection index， etc.， were observed and compared between the two groups.
Results
Compared with the two groups， the study group's incision length and operation time were shortened， the intraoperative blood loss was decreased， and the postoperative VAS score was decreased （P＜0.05）. Compared with the control group， the study group's postoperative Mayo elbow joint function score was significantly increased （P＜0.05）. Postoperative elbow flexion-extension motion and forearm rotation motion were significantly improved in the study group. There was no significant difference in other observation indexes between the two groups.
Conclusion
The internal fixation with Kirschner and wire tension band for olecranon osteotomy， compared with plate fixation， can shorten the operation time and surgical incision length， reduce intraoperative blood loss， and reduce postoperative pain，which can promote the recovery of elbow motion and improve elbow function. There is also a lower risk of postoperative elbow stiffness than with plate fixation.
Although proximal humeral fractures combined with ipsilateral humeral shaft fractures are rare， in recent years， with the increase of high-energy injuries， the incidence rate has been increasing yearly and can account for 1%-2% of all humeral fractures. Due to its multiple and complex fractures， there are many difficulties in its treatment， and factors such as intraoperative reduction， selection of internal fixation， and functional rehabilitation exercises need to be considered.Traditional treatment mainly adopts conservative treatment， which has a long fixation time and is prone to complications such as nonunion of fractures and joint stiffness. Therefore， more and more patients are adopting surgical internal fixation treatment. Currently， intramedullary nails （IMN） and locking plate osteosynthesis（LPO）may be considered for the fixation of proximal humeral fractures combined with humeral shaft fractures. LPO can provide stable fixation and has strong angular stability. However， the surgery requires extensive dissection of soft tissues and disruption of the periosteal blood supply， which may lead to delayed healing or nonunion of fractures. Although IMN reduces soft tissue dissection injury and enables early weight-bearing activities， its disadvantages include rotator cuff damage and unstable rotation.
Objective
To compare the efficacy of intramedullary nails and locking plates in treating proximal humeral fractures combined with humeral shaft fractures was clarified.
Methods
Based on the inclusion and exclusion criteria， a retrospective analysis was conducted on the clinical data of 41 cases of proximal humeral fractures combined with ipsilateral brachial shaft fractures admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2024. They were divided into the intramedullary nail treatment group （IMN） and the locking plate treatment group（LPO） according to different fixation methods. The operation time， surgical bleeding， incision length，fracture healing time， Constant-murley score（CMS）， and the disabilities of the arm， shoulder，and hand score（DASH） were evaluated.
Results
The average operation time of the LPO group was（92.25±16.18）min， and that of the IMN group was （96.43±22.98）min. The two groups had no statistically significant difference （t=0.670， P=0.507）. The average surgical blood loss in the LPO group was （176.75±91.14）ml， and that in the IMN group was （107.86±26.39）ml. The IMN group was significantly better than the LPO group （t=3.253， P=0.004）. The average incision length of the LPO group was （17.90±4.28）cm， and that of the IMN group was（7.67±0.73）cm. The IMN group was significantly better than the LPO group （t=10.803， P=0.000）. The average fracture healing time in the LPO group was （13.85±1.79）weeks， and that in the IMN group was （12.67±1.24）weeks.The IMN group was significantly better than the LPO group （t=2.476， P=0.018）. The average CMS score of the LPO group was （86.65±6.91）points， and that of the IMN group was（88.29±6.87）points. The two groups had no statistically significant difference （t=0.760， P=0.452）.The average DASH score of the LPO group was （16.00±6.36）points， and that of the IMN group was（12.57±5.11）points. There was no statistically significant difference between the two groups （t=1.909，P=0.064）.
Conclusion
Both LPO and IMN can be used as effective measures for treating proximal humeral fractures combined with ipsilateral humeral shaft fractures. However， IMN shows obvious advantages in reducing surgical bleeding， shortening surgical incision length， and fracture healing time.
Proximal humeral fractures are common upper limb fractures and have a high incidence among middle-aged and older adults， usually caused by low-energy falls. With the intensification of global population aging， the incidence of proximal humeral fractures is also increasing.Recent epidemiological studies have pointed out that the majority of proximal humeral fractures are displaced. Elderly patients， due to osteoporosis and decreased bone density， tend to have more complex fractures when they occur and face more challenges in the treatment process. For displaced and unstable proximal humeral fractures， open reduction and internal fixation remain the preferred treatment methods when bone quality permits. Open reduction and internal fixation not only help restore the anatomical position of the fracture site but also effectively relieve pain and promote early rehabilitation. Proximal humeral fractures are often accompanied by relatively obvious osteoporosis， which makes internal fixation treatment face many difficulties. Osteoporosis leads to bone fragility in the fracture area， which affects the stability of the fixation device and increases the risk of postoperative complications. The most common complication after internal fixation of proximal humeral fractures is the varus deformity of the humeral head. Varus not only affects postoperative shoulder joint function but may also lead to complications such as subacromial impingement， internal fixation failure， and screw protrusion due to changes in the rotation center of the humeral head， resulting in pain and functional disorders in patients. Clinically， for cases with medial cortical fragmentation， methods such as enhancing the internal fixation torque through intramedullary nails or increasing stability through intramedullary fibular bone grafting can prevent the inversion and collapse of the humeral head after surgery. Although these measures can effectively prevent the occurrence of humeral head varus and collapse， the mechanism of changes in the bony structure and internal fixation of the proximal humerus caused by humeral head varus has not been fully clarified so far. The occurrence of varus deformity may be closely related to multiple factors such as fracture type， postoperative reduction condition， bone condition， and the choice of internal fixation. Therefore， in-depth research on the pathological mechanism and imaging manifestations of inversion after proximal humeral fracture surgery has practical clinical significance. Through imaging measurements， especially the evaluation of geometric indicators after humeral head inversion， a basis can be provided for further optimizing the treatment plan.
Objective
To investigate the radiographic characteristics and correlations of varus deformity following locking plate fixation for proximal humeral fractures.
Methods
A retrospective analysis was conducted on patients with locking plate internal fixation of proximal humeral fractures who underwent surgical treatment from September 2014 to September 2024. A total of 53 patients with humeral head inversion after surgery （22 males and 31 females， with an average age of 61.3 years±5.4 years） were screened out. The following parameters were measured by anterior-position X-ray films of the scapula one year after surgery：（1）Humeral head trunk angle （HSA）； （2）Large nodule - acromial distance （GT-AC）； （3）Medial cortical interpolation（MI）； （4）Rotation center height difference（）； （5）Large nodule - humeral head distance. Pearson correlation analysis was used to assess the relationships between various imaging indicators.
Results
HSA was significantly positively correlated with GT-AC （r=0.694， P＜0.001）， HSA was significantly negatively correlated with MI （r= -0.986， P＜0.001）， articular surface-large nodule distance （r=0.063， P=0.656），and （r=0.015， P=0.912） had no significant correlation with the degree of inversion.
Conclusion
The shortening of medial cortical intercalation and the reduction of the distance between the large nodule and the acromion is significantly associated with humeral head inversion. In the clinical assessment of humeral head inversion after proximal humeral fracture surgery， these concomitant pathological mechanisms should be considered.
）； （5）Large nodule - humeral head distance. Pearson correlation analysis was used to assess the relationships between various imaging indicators.
（r=0.015， P=0.912） had no significant correlation with the degree of inversion.