Comparison Of The Effect On Humeral Shatf Fractures With Open Reduction And Plate Screw Fixation And Closed Reduction And Internal Fixation With Intramedullary Nail

Objective: The evaluation of the clinical effect on the treatment of the humeralShaft Fractures with the open reduction and plate screw fixation and the closedreduction and internal fixation with intramedullary nail.Methods: A total of72cases of the humeral shaft fractures, which meets theinclusion criteria in the first affiliated hospital of Dalian medical university From2007to2011, is retrospectively analyzed; the range of their ages is21to68years old and theaverage of them is37.69±17.77years old, in which there are42cases of male and30cases of female;43cases of fracture patients of are treated with the open reduction andplate screw fixation, and29cases are treated with closed reduction and internal fixationwith intramedullary nail. Comparing two groups of postoperative fracture healing, wefind that the iatrogenic radial nerve had injured and infected to result in the change ofthe shoulder joint activity range and the shoulder joint pain, which caused whether thesecondary surgery is needed.Results:31cases treated with the open reduction and plate screw fixation all reachthe healing standard, as25cases with closed reduction and internal fixation withintramedullary nail do.8cases treated with open reduction and plate screw fixationdelays union and4cases don’t heal, and3cases with closed reduction and internalfixation with intramedullary nail delay union and1case doesn’t heal. The healing ratebetween the two groups of the open reduction and plate screw fixation and the closedreduction and internal fixation with intramedullary nail is no significant difference (p>0.05). In the group of the open reduction and plate screw fixation and the closedreduction, the failure of healing after treatment have4cases, in which one case iscaused by the internal fixation failure and implant failure. For these patients, the secondary surgery is needed with the steel plate screw fixation and the bone grafting,they can heal after6months. After the treatment of the closed reduction and internalfixation with intramedullary nail,1case appears the un-healing of bone, and after thesecondary surgery with plate fixation and bone grafting, the bone heals. In the group ofthe open reduction and plate screw fixation, the slightly abatement of the range ofactivity is3cases with the moderate abatement is2cases, and the notable abatement is2cases. In the group of Intramedullary nail, the slightly abatement of the range ofactivity is4cases the serious abatement is1case, and the extreme abatement is1case.The range of the shoulder joint activity between the two group of the open reductionand plate screw fixation and the closed reduction and internal fixation withintramedullary nail is no significant difference（p>0.05）. There are8cases hascontinuous pain of shoulder joints after one year of treatment, in which1case is treatedwith open reduction and plate screw fixation and7cases are treated with closedreduction and internal fixation with intramedullary nail, and the same time, one patientappears the frozen shoulder. After treatment, there are6cases with the iatrogenic radialnerve injuries and2cases of which are treated with the closed reduction andintramedullary nail. In the2group, the patients have on infection. The complication ofthe patients with the closed reduction and intramedullary nail is more than them withthe open reduction and plate screw fixation.Conclusion: In this retrospective study, For humeral fracture, closed reduction andinternal fixation with intramedullary nail an open reduction achieved similar results, but closedreduction and intramedullary nail group had more complications after surgery, especially in theshoulder joint pain. Based on the research, we suggest that the open reduction and platescrew fixation is the main method to treat the humeral shaft fractures.