The BRRD demonstrated its efficacy in efficiently reducing fracture end dislocation, resulting in the restoration of the neck-shaft angle close to normal. This successful reduction contributed to favorable clinical outcomes for the majority of patients.
A notable advantage of the device is its capacity for rapid restoration of fracture end, thereby reducing surgical time. The BRDD is designed to withstand high-temperature and high-pressure disinfection, making it suitable for placement on the intraoperative sterile operating table. Its user-friendly nature is amplified by its easy installation procedure, with the entire installation process requiring approximately 5 minutes. The positioning of the traction rod anterior to the arm ensures that it does not obscure the incision. Moreover, the device generates sustainable forces, preventing the redisplacement of the fracture end. Previous literature has reported operation times ranging from 70.92 to 109.7 minutes[12, 13]. In the present study, the average operative time was 70.92 min, demonstrating a decrease in the time required for fracture reduction and an overall improvement in operation efficiency.
In the context of MIPO surgery for PHFs assisted by the BRDD, a notable benefit observed is the reduction in radiation exposure time. Prior studies have reported that radiation exposure times during internal fixation of PHFs ranging from 38.5 to 68 s[7, 13]. Remarkably, our study exhibeted a mean radiation times of 19.58s, signifying a substantial reduction compared to previous reports. The BRRD’s capability to maintain stable and continuous traction force contributes to efficient reduction, consequently leading to a decrease in radiation exposure times.
The attainment of a normal neck-shaft angle stands as a crucial indicator of successful reduction in PHFs[14]. The designated normal range for the neck-shaft angle typically falls between 120°and 135°[15]. In our study, the postoperative NSA recorded was 144.62 ± 9.17°, and it was 136.66 ± 7.83° at one-year follow-up, ultimately returning to the normal range. This achievement can be attributed to the following factors: 1. The traction force, aligned with the axis of the humerus, demonstrates increased strength. 2. The soft tissues surrounding the shoulder generate a cuff-like force, contributing significantly to the anatomical reduction of the bone fragments.
Previous studies have found a varied CMS score ranging from 68 to 87 in the final follow-up for the treatment of PHFs with MIPO technique[12, 16, 17]. In our study, the average CMS score was 86.92, surpassing the majority of reported scores in previous literature. The improved outcomes can be attributed to several factors, including effective reduction of fracture end, minimized disruption to blood circulation, and early rehabilitation protocols. However, it is essential to note that further validation of these conclusions necessitates large-sample randomized controlled trials.
Complications in the current series were minimal, highlighting the significance of avoiding axillary nerve injury in MIPO surgery for PHFs. Procedures involving soft tissue separation and screw insertion across the anterior branch of the axillary nerve were conducted carefully. The sustained force generated by the BRDD effectively moved the anterior branch of the axillary nerve away from humerus cortex, thereby reducing the risk of nerve injury.
In conclusion, our findings suggest that BRDD is a potentially safe and effective tool for MIPO in PHFs. However, the limitations of our study, particularly the small sample size, underscore the need for further exploration. A comprehensive multicenter, large-sample clinical study is warranted to substantiate our initial observations.