Three Internal Fixations Of Surgical Neck Fractures Of Humerus

ObjectiveTo compare the effect of surgical treatment for surgical neck fractures of proximalhumerus by AO T-Plate,LPHP and K-wire,while analyse their advantages anddisadvantages.Patients and Methods.Retrospectively analyzed surgically treated 46 cases of surgical neck fractures ofproximal humerus that can be followed up during 2000.7 to 2006.7 in XiangYaHospital,20 cases in which were treated by AO T-Plate,16 by LPHP,10 by K-wire,compared the effect of these three methods. According to the effect standard ofConstant-Murley shoulder accessment, the scores in 90～100 average isexcellent,80～89 good,70～79 moderate,～70 bad.ResultsAll these cases were followed up for 5 to 77 months with a average of 37months.In AO T-Plate group,MOT(mean operating time) were 130min, MBV(mean bleedingvolume) were 120ml,MHT(mean heal time) were 14weeks,All 20 fractures healed,1case suffered screw loosen 1 month after operation, this was treated by reseting thescrew and titen the plate.1 suffered avascular necrosis of humeral head after 2years,this was treated with a TSA (Total Shoulder Athroplasty) in 3rd year after theoriginal operation.The rate of complication is 10％.The recovery was eventuallysatisfactory. We found 16 excellent,2 good,1 moderate,1 bad with an 90％good-and-excellent rate in this group.In LPHP group,MOT:100min,MBV:110ml,MHT:12weeks.all 16 fratures werehealed with only 1 case suffered avasscular necrosis of the humeral head.The rate ofcomplication is 6.3％.We found 14 excellent,1 good ,1 moderate and no bad with a93.8％excellent-and-good rate in this group.In K-wire group,MOT:90min, MBV:70ml,MHT:10weeks.All 10 fractures werehealed with 2 cases suffered wire shifting, 1 suffered delayed union,2 suffered poor shoulder function.The rate of complication is 50％.We found 4 execellent,1 good, 4moderate and 1 bad with a 50％excellent-and-good rate in this group.Afer statistical F and Chi-Square Test,there was significant difference in rate ofexcellent-and-good among the three groups and one to each other(P＜0.05).The distantincidence of postoperative complications among the three groups and one to eachother have significant difference too(P＜0.05).No difference were found by operatingtime(p＞0.05). Bleeding volume and union time still have statisticalsignificancy.(P＜0.05)Conclusion1. According to the results, we concluded that LPHP & AO T-plate displayedadvantages of tough fixation, less complication than K-wire, much more possibility ofearly functional exercise, leading to better function of the shoulder joint.2. K-wire displayed the advantages of less surgery trauma and shorter uniontime, is suitable for the moderate fractured patient with slightly replacement of thefractures.