Views: 169 Author: Site Editor A chhuah hun: 2023-01-29 A bul tanna: Hmun
Proximal humerus fracture hi trauma orthopedic-a fracture awm tam ber pakhat a ni a, proximal humerus fracture tam zawk hi tarte zingah low-energy osteoporotic fracture a ni.
Proximal humerus fracture tam zawk hi conservative takin 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 a zirin a ni tur a ni.
【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.
【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%).
[Recommendation] Preoperative education hi diversified leh multi-modal hmanga kalpui tur a ni. (Mithiamte rawtna rate: 100%; rawtna chak tak: 83.8%)
【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%)
【Recommendation】Elective surgery nei zunthlum vei tam zawk tan glycemic control target rawt chu 7.8 atanga 10.0 mmol/L a ni.
【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%)
【Recommendation】 Elective surgery nei damlote chuan operation hma darkar 2-ah in tur thianghlim tak tak an ei thei a, operation hma darkar 6-ah starchy foods emaw dairy products emaw an ei thei bawk. (Mithiamte rawtna rate: 100%; rawtna chak tak: 76.5%)
【Recommendation】Proximal humerus fracture surgery atan hian routine perioperative urinary catheterization hi hman a tha lo (Expert recommendation rate: 100%; Strong recommendation rate: 78.6%)
【Recommendation】Proximal humerus fracture 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%)
【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%).
[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 a awm loh nan hemodynamic stability vawn reng hi ngaihven tur a ni (expert recommendation rate: 100%; strong recommendation rate: 61.9%).
[Recommendation] Goal-oriented fluid management strategy kalpui la, general anesthesia neih chhung hian 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%).
[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%).
[Recommendations] Proximal humeral fractures nei damlote chuan intraoperative temperature monitoring 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%).
[Recommendation] Neer’s staging hi proximal humerus fracture staging atan a tha hle (expert recommendation rate: 100%; strong recommendation rate: 83.3%).
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.

Figure 1 Hmeichhia kum 65 mi, proximal humeral adductor insertion hmun 4-a fracture leh allograft fibular implant plate fixation incision leh repositioning nei.
[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%).
【Recommendation】Surgical incision chu simple interrupted, layer-by-layer sutures hmangin khar a ni (expert recommendation rate: 100%; strong recommendation rate: 76.2%).
【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.
【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.
【Recommendation】Proximal humeral fractures nei damlote tan chuan operation hnua analgesia hman 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.
[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%)
【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 dan tha zawka siam that nan a pui thin (Expert recommendation rate: 100%; Strong recommendation rate: 92.9%).
【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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Thu belhchian dawl zawk hriat duh chuan,click rawh CZMEDITECH ah hian a chipchiar zawkin a awm.
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