A Comparative Study Between Using Locking Humerus Plate And Using Artificial Shoulder Arthroplasty For The Treatment Of Three And Four-part Proximal Humeral Fractures In The Elders

Objective:Fractures of the proximal humerus mostly take place in the elders with osteoprosis, secondary osteo-defectes caused by fracture usually result in lots of difficulties. This study is to compare the clinical efficacies of ORIF and HHR in the treatment of three and four-part proximal humeral fractures, and to choose better method for treating them.Methods:A cohort of 37 follow-up patients (twenty-three women and fourteen men; mean age, seventy years) are available for the study. Thirty (82%) of the injuries are three-part fractures; Seven (18%) are four-part fractures; five(13%) of which are associated with dislocation of the shoulder.All fractures are fixed with ORIF and HHR. Over a mean follow-up period of 16 months, functional outcome is assessed with the Constant score. The clinical datas are analyzed for the patients with three and four-part proximal humeral fractures undergoing surgeries for ORIF and HHR. Constant scores,Neer scores and ASES scores are used to determine the excellent clinical outcome rates in the two groups, and the operating time, incisal opening length, blood loss, hospital day, postoperative complications and functional rehabilitation of the shoulder are compared by statistical package for social science (SPSS16.0). Student-t test and Chi-square test are used to determine differences between two groups.Results:Seventeen patients in HHR group are evaluated. According to the Constant scores, excellent outcomes are achieved in 6 patients, good outcomes in 6 patients, moderate in 5 patients, and poor in 0 patients, with an excellent outcome rate of 70.6%. In the 20 cases receiving ORIF, excellent outcomes are achieved in 8 cases, good in 4 cases, moderate in 7 cases, and poor in 3 cases, with an excellent clinical outcome rate of 60.0%. Twelve months after surgery, the mean Constant score for the HHR group is 79.1±5.5 points, corresponding to 70.9±6.3 points of the score for the ORIF group(p<0.05). Compared with ORIF, HHR is associated with shortened cut length, reduced blood loss and better motor function recovery of the shoulder. Results are considered no significantly different between the Constant Functional Score of operation time, hospital day and six-month after postoperative Joint function, after 12months follow-up, Complications in the group treated with ORIF included subluxation of joint in one patient,osteonecrosis in two patients, joint stiffness in three patients and a patient has a deep wound infection.Complications in the HHR group included joint stiffness in one patient, ectopic ossification in one patient and one patient has subacromial impingement.Conclusion:Both ORIF and HHR are effective methods in treatment of complex proximal humerus fractures in the ageds. However, HHR produces better clinical outcomes than ORIF in patients with three and four-part proximal humeral fractures, and can promote the short-term functional recovery of the shoulder with minimal surgical complications.