Proximal humerus fracture hi trauma orthopedic-a fracture awm tam ber pakhat a ni a, proximal humerus fracture tam zawk hi tarte zingah chuan low-energy osteoporotic fracture a ni.
Proximal humerus fracture tam zawk hi conservative taka enkawl theih ni mahse, fracture 10-15% chu surgical treatment a la ngai a, chutah chuan incisional reduction plate fixation, closed reduction intramedullary nail internal fixation, leh joint replacement te a tel a ni.
Enkawlna chungchanga thutlukna siam tur chu damlo taksa dinhmun, a ngaihdan, rilru lam beisei leh ruh tliak chi hrang hrang atanga thlir a ngai a ni.
Emergency fracture te reset leh fixation te
【Recommendation】Proximal humeral greater tuberosity (NEER type 2 partial fracture) fractures combined with shoulder dislocation, preoperative CT examination, surgical neck region-a fracture tih loh chu, emergency anesthesia hnuaia traumatic shoulder brace hmanga repositioning leh braking (expert recommendation rate: 100%; strong recommendation rate: 76.2%) a ni.
2. Operation hmaa acute pain control
【Recommendation】Proximal humerus fracture nei damlote chuan preoperative analgesia oral acetaminophen emaw NSAIDs emaw hmanga pek an duh zawk a, oral opioids pawh a that loh chuan dah theih a ni (expert recommendation rate: 100%; strong recommendation rate: 73.8%).
3. Operation hmaa missionary zirna
[Recommendation] Preoperative education hi diversified leh multi-modal hmanga kalpui tur a ni. (Mithiamte rawtna rate: 100%; rawtna chak tak: 83.8%)
4. Operation hmaa nutritional assessment leh supportive treatment neih a ni
【Recommendation】Damlote admission atanga 24 h chhunga nutritional screening tihfel leh nutritional risk nei damlote tana nutritional intervention pek. (Mithiamte rawtna rate: 98.5%; rawtna chak tak: 55.9%)
5. Zunthlum vei damlote perioperative glucose assessment leh regulation
【Recommendation】Elective surgery nei zunthlum vei tam zawk tan glycemic control target rawt chu 7.8 atanga 10.0 mmol/L a ni.
6. Perioperative period chhunga soft tissue swelling enkawl dan
【Recommendation】Proximal humerus fracture avanga elective surgery nei damlote tan chuan perioperative period chhunga swelling tihziaawmna turin physical method hrang hrang pek thin a ni. (Mithiamte rawtna rate: 98.5%; rawtna chak tak: 80.9%)
7. Operation hmaa ei leh in enkawl dan
【Recommendation】 Elective surgery nei damlote chuan operation hma darkar 2-ah in tur thianghlim an ei thei a, operation hma darkar 6-ah starchy food emaw dairy products emaw an ei thei bawk. (Mithiamte rawtna rate: 100%; rawtna chak tak: 76.5%)
8. Operation laiin urinary catheter hmanga enkawl dan tur
【Recommendation】Proximal humerus fracture surgery atan hian routine perioperative urinary catheterization hman a tha lo (Expert recommendation rate: 100%; Strong recommendation rate: 78.6%)
9. Perioperative antimicrobial damdawi hman dan tur (prophylactic application) a ni
【Recommendation】Proximal humerus fractures nei, endoprosthesis emaw joint replacement emaw nei tan chuan perioperative period-a infection venna atan first- leh second-generation cephalosporins prophylactic hman a tha. (Mithiamte rawtna rate: 97.1%; rawtna chak tak: 73.5%)
10. Anesthesia hman dan tur thlan dan
【Recommendation】Anesthesia hi regional block compound general anesthesia method hman a, damlo kum upa lam systemic organ dysfunction tizual lo turin damdawi thlan a, monitoring tihchakna tur ngaihven a tha (expert recommendation rate: 100%; strong recommendation rate: 71.4%).
11. Operation chhunga thisen sang control
[Recommendation] Proximal humeral fractures avanga intraoperative blood loss tihtlem nan thisen sang tihhniam tlemte chu ngaihven tur a ni a, mahse comorbidities tam tak nei damlo tarte chuan tissue leh organs perfusion tha tawk lo an awm loh nan hemodynamic stability vawn reng hi ngaihven tur a ni (expert recommendation rate: 100%; strong recommendation rate: 61.9%).
12. Operation chhunga volume enkawl dan
[Recommendation] Goal-oriented fluid management strategy kalpui la, general anesthesia neih laiin vasoactive drugs chu prophylactically-in pek theih a ni a, chu chuan fluid overload a awm loh nan (expert recommendation rate: 100%; strong recommendation rate: 69.1%).
13. Operation chhunga thisen enkawl dan
[Recommendations] Proximal humeral fractures tan chuan intraoperative controlled hypotension hi a tha lo hle a, a bik takin damlo kum upa lam tan chuan intraoperative blood transfusion leh tranexamic acid pawh hman theih a ni. HGB <80g/L intraoperative check chuan allogeneic thisen pek a tha (expert recommendation rate: 100%; strong recommendation rate: 73.8%).
14. Intraoperative hypothermia venna
[Recommendations] Proximal humeral fractures nei damlote chuan intraoperative temperature monitoring an tichak tur a ni a, core temperature 36°C aia sang a awm theih nan hmalakna hrang hrang an nei tur a ni (expert recommendation rate: 100%; strong recommendation rate: 76.2%).
15. Surgery tih dan tur thlan dan
(1) Proximal humerus-a ruh tliak (fracture staging) a awm
[Recommendation] Neer’s staging hi proximal humerus fracture staging atan a tha ber (expert recommendation rate: 100%; strong recommendation rate: 83.3%).
(2) Surgery hmanga tih dan
Surgical plan hi fracture morphology, ruh quality, damlo taksa leh rilru dinhmun leh thil dang kaihhnawih a zirin thlan tur a ni.
[Recommendation] Internal fixation material chu fracture type leh bone density a zirin thlan theih a ni a, plate emaw intramedullary nail emaw ang chi te kum upa lam, ruh natna vei, reset emaw siamthat emaw harsa tak takte tan chuan, 4-part fracture (leh fracture dislocation), 3-part fracture with severe osteoporosis, split fracture leh anatomical neck fracture, artificial shoulder joint replacement thlan a ni a, rotator cuff injury nena inzawm chuan reverse shoulder joint thlak a tha (expert recommendation rate: 100% (Recommendation chak tak: 71.4%) a ni.
![Proximal humerus tihchhiat a ni]()
Figure 1 Hmeichhia kum 65 mi, proximal humeral adductor insertion hmun 4-a fracture leh allograft fibular implant plate fixation incision leh repositioning nei.
16. Hliam chhuahna tube dahna tur
[Recommendations] Drainage tube dah lohna tur hriattirna: 1 Minimally invasive operation techniques (MIPPO leh intramedullary nailing); 2 Thisen chhuah tlem. Drainage tube dahna tur hriattirna: 1 pectoral deltoid approach hmangin, locking plate fixation emaw shoulder joint thlak emaw; 2 hliam chunglam atanga thisen chhuak nasa tak (expert recommendation rate: 100%; strong recommendation rate: 71.4%).
17. Hliam khar
【Recommendation】Surgical incision chu simple interrupted, layer-by-layer sutures hmangin khar a ni (expert recommendation rate: 100%; strong recommendation rate: 76.2%).
18. Operation hnua dam lehna ei tur
【Recommendation】Damlote chuan operation hnua an harh hnuah dregs-free drinks chu hmui hmangin an in thei a, adverse reaction a awm loh chuan 1-2 h hnuah normal diet an hmang leh thei bawk.
19. Postoperative position thlan leh hmalakna hmasa ber
【Recommendation】Damlote chu operation hnuah pillow-ah an muhil a ngai lo va, semi-recumbent position an hmang thei a, an harh hnuah pawh leiah an che thei bawk. Traumatic shoulder brace chu brake a ni tur a ni.
20. Operation hnua natna tihdamna hmanrua
【Recommendation】Proximal humeral fractures nei damlote tan postoperative analgesia hi NSAIDs 'background doses' pangngai nena inzawm regional blockade hman a tha a, a tul chuan intravenous self-administered analgesia pump emaw peripheral nerve block self-administered analgesia pump emaw hman a tha (expert recommendation rate: 100%; strong recommendation rate: 78.6%) a ni.
21. Operation hnua nausea leh luak chhuak laka invenna
[Recommendation] Damlo zawng zawngte chu operation zawh hma min 30-ah prophylactic antiemetic medication pek vek tur a ni. (Mithiamte rawtna rate: 97%; rawtna chak tak: 47.8%)
22. Hnathawh lama siamthatna
【Recommendation】Fixed leh stable proximal humerus fractures nei damlote chuan operation hnuah a hma thei ang bera rehabilitation exercise an tan tur a ni. Rehabilitation exercise hian taksa peng chunglam hnathawh thatna tur a siam tha zawk thin (Expert recommendation rate: 100%; Strong recommendation rate: 92.9%).
23. Discharge criteria leh zawm dan tur
【Recommendation】Practical discharge criteria siam tur a ni a, damlote chu thla 6 tal enkawl reng tur a ni (expert recommendation rate: 100%; strong recommendation rate: 83.3%).
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