Treatment Of Proximal Humerus Fractures With Locking Plates In Oseoporsis Patiens: An Clincal Study

Object:Fractures of the proximal humerus are a typical injury of the elderly patient over50years of age. The majority of these fractures are related to osteoporosis. Poor bone qualitymakes screw purchase and fixation less secure can result in malunion, displace and failureof implant fixation. Stable fixation（intramedullary nails and conventional plating）is hardto achieve in osteoporotic bone stock because anchoring of screws is difficult in thesecases, leading to high rates of fixation failure, especially when conventional fixationtechniques are used. Locking plate technology has been developed as a solution to theproblems encountered during conventional plating to treat fractures in osteoporotic boneparticularly with metaphyseal comminution. The key to this technology is fixed anglerelationship between the screws and plate. The threaded screw heads are locked into thethreaded plate holes to prevent screw toggle, slide and pull out, thus diminishing thepossibility of primary or secondary loss of reduction. Because of the good fixation, there ispotential of enhanced stability that could allow early mobilization. However till now verylimited prospective studies have been done describing the functional outcome followinglocking plate fixation of proximal humeral fractures. Thus the objective of our study was todetermine the efficacy of LCP in managing proximal humeral fractures with osteoporosisin elderly patients.Method:This prospective study included a series of47patients (age>50) operated betweenSeptember2008and Feb2010with a proximal humerus locking plate for the proximalhumerus fracture.All proximal humeral fractures met the indications for the operative treatmentoutlined by Neer. Using plain radiographs, all fractures were classified according to Neerclassification. Osteoporosis in28patients was confirmed by bone mineral density measure. （15patients used traditional plating to treat fractures and13patients used locking platesto treat fractures）Non-osteoporosis in19patients was confirmed by bone mineral densitymeasure（10patients treated fractures with traditional plating and9patients used lockingplates to treat fractures）All case were divided into four experimental groups according to the type of platesand whether or not accompaniment with Osteoporosis,All patients were followed up for6-8months postoperatively and then all data wassystematically reviewed. according to Neer criteriaComparison was performed accordingto Neer score[13]. Neer score included Postoperative pain (35), Functio（n30），ROM（25），Anatomical location（10），The score was graded as Failure (0-70points),Unsatisfaction(71-80), satisfaction (80-85) or excellent (86-100).Inclusion:Locking compression plate (LPHP) is anadvantageous implant in proximal humeralfractures due to angular stability, particularly in comminuted fractures and in osteoporoticbones in elderly patients, thus allowing early mobilization，and reduce internal fixationcomplication，Certainly,further comparative clinical studies are necessary to verify thisconcept.