Clinical Analysis Of Locking Plate And Artificial Joint Replacement For Comminuted Proximal Humeral Fractures

Purpose of proximal humerus fractures account for approximately4%to5%of all fractures, which accounts for about26%of shoulder fractures, especially in elderly patients with osteoporosis sees, are common in the elderly a metaphyseal fractures. Fractures are often accompanied by varying degrees of bone defect, for the clinical operation treatment has caused great difficulties, this paper through the contrast analysis of plate internal fixation and artificial humeral head replacement for the treatment of proximal humerus Neer three or four part fractures of the clinical effect and its clinical application value, to explore the elderly patients with proximal humeral comminuted fractures of the ideal treatment method.Methods from20090ctober to2011December in Wuhan City Department of orthopedics hospital treated a total of proximal humerus comminuted fracture operation38cases (male14, female24cases; mean age64.6years), are unilateral, of which Neer three part fractures in23cases (68%), the four part fractures in15cases (32%), with shoulder joint dislocation in3cases (11%). Divided into plate internal fixation group (ORIF group) and artificial humeral head replacement group (HHR group). After a mean follow-up of18months, according to Neer score evaluation group two in good to excellent yields, two groups of postoperative pain, activity, anatomic location. Shoulder joint function recovery and complications were compared between the two groups results etc..Results38cases in this group, all patients at a mean follow-up of18months, no death case. Using Neer scores in two groups of the excellent and good rate of ORIF group,20cases,20cases were followed up, efficacy was excellent in8cases, good in8cases, in4cases, poor in1cases, the excellent and good rate was78.5%.18cases in group HHR, follow-up of15cases. Efficacy was excellent in10cases, good in4cases, in1cases, poor in0cases, the excellent and good rate was89.6%. Prosthesis replacement group mean Neer score (89.6+5.5) superior incision fixation group (78.5+6.3)(P0.05), HHR group relative to the ORIF group in postoperative pain, activity, anatomic location. Shoulder joint function recovery and complications weresignificantly dominant. After one year follow-up, group ORIF complications included lcases of humeral head osteonecrosis,1patients with impingement,2cases of shoulder joint stiffness. Group HHR complications included1cases of articular heterotopic ossification andl patients with impingement. Conclusion artificial humeral head replacement and open reduction and plate osteosynthesis are in treatment of senile comminuted proximal humeral fractures is effective method. Relative to the locking plate fixation in the treatment of senile proximal humeral Neer three or four part fractures, humeral head replacement can significantly relieve pain, early functional exercise, functional recovery is faster, reduce the postoperative complications, is the treatment of complex fractures of proximal humerus of a ideal method.