Locking Proximal Humerus Plate In Treatment Of Complex Proximal Humerus Fractures In The Elders

Objective :Fractures of the proximal humerus mostly take place in elders with osteoprosis, secondary osteo-defect caused by compression fracture usually result in internal fixation failure and re-displacement of post-reduction. According to the bone density of different region in proximal humerus, selection of the suitable internal fixation is one of the priority of the surgeon's consideration. With locking screws firmly fixed the plate and fractures as whole unity, locking plate system provide a very unique solution for the fracture of proximal humerus in elders with osteoprosis, result in less internal fixation breakdown and more effective healing of cancellous bone fractures. This study is to evaluate surgical treatment of complex proximal humeral fracture in the elders with locking proximal humerus plate.Methods :From July 2006 to Oct. 2008, nineteen complex fractures of the proximal humerus treated with locking proximal humerus plate were retrospectively analysed. All the patients were treated by ORIF, there were five male and fourteen female, aged from 65 to 79, 72 years old in average. Fourteen patients were fractured in right arm and three others in the left side. For the cause of the injury, ten traffic accident injuries, six standing falling and three riding falling injuries. Three of them combined with shoulder dislocation. Operations were performed 5-10 days after injury, 7.5 days in average. According to Neer classification, there were 11 cases of three-part fractures and 8 cases of four-part fractures. All cases were combined with chronic diseases,7 cases with diabetes mellitus,2 with pulmonary infection,16 with hypertension,3 with cerebral infarction.Results: The average time for the fixation operation was about 81 minutes. Post-operative X-ray showd that all cases were anatomic reducted and properly fixated. Following-up were from nine to thirty-six months, twenty-four months in average. The average time for fracture union was 12 weeks (range from 8-16 weeks), there was no internal fixation loosing and breakdown. By Constant scoring system, nine case got excellent results, eight was good and two fair, the excellent and good rate was 89.5%. There was no surgical infective complication.Conclusion :Application of locking proximal humerus plate can result in more reliable fixation, higher bone union rate, earlier rehabilitative and better functional recover in treatment of complex fractures of the proximal humerus, especially in the elders with osteoprosis. Application of MIPPO and LCP techniques provide better effective solution for the treatment of the proximal humerus fractures in elders with osteoprosis, and are expected to solve the complecated problems caused by other internal fixative methods. This locking system is worthy of clinic application and further clinical study should be presented.