| Objective: Proximal humeral fractures are common fractures that usuallyoccur in the elderly patients. Due to an ageing population, the incidence ofproximal humeral fractures of osteoporotic patients is expected to increase infuture. Due to the characteristics of osteoporosis, reduction and stablefixation of such fractures remain a challenge, and more and more attention hasbeen attracted. Using the locking plate for the treatment of such fracturesimproved the stability of fixation. Patients treated with locking plate can bemobilized earlier and get better functional recovery. However, thecomplication rates remain high. The essentiality of operation are rigidfixation and keeping an intact humeral head. Biomechanical study suggestedthat subchondral screw-tip abutment significantly increased the stability ofplant. With the traditional surgical method, the depth of drilling isdetermined by the tactile feedback of the bit against the subichondral bone.Given the characteristics of osteoporotic patients, a surgical method that wascalled “sounding” was reported in the literature, after the near cortex of thedesired locking screw slot was perforated using a drill bit, Kirschner was usedto be advanced by hand until a firm end point was felt. The tactile feedbackof the Kirschner wire against the subchondral bone likely served as a moreaccurate assessment of depth. In our study, a depth gauge was used insteadof kirschner for the betterment. The purpose of our study was to assess theclinical effects of two different operation methods for the treatment ofproximal humeral fractures of osteoporotic patients.Methods: Totally40patients of proximal humeral fractures from Aug.2012to Feb.2013in the Third Hospital of Hebei Medical University.Patients were included in this analysis based on the following criteria:1) age__________________________________________________________________________________________ ＞55;2) acute fracture, and the patients received the treatment of surgerywithin2weeks after an injury;3) osteoporosis;4) if the patients had othercomplications, such as diabetes, hyperthyroidism, and severe heart, lung, liver,kidney dysfunction. All the patients were treated with lock plates, and wereseparated in two group,20cases received traditional method, another20casesreceived sounding method. In the traditional surgical method group, thedepth of drilling is determined by the tactile feedback of the bit against thesubchondral bone. In the sounding method group, after the near cortex andpart of the cancellous bone of the desired locking screw slot was perforatedusing a drill bit, the depth gauge was used to be advanced by hand until a firmend point was felt and measured the depth directly. Through this method, thetactile feedback against the subchondral bone would be more accurate.Operation time, peri-operative bleeding, exposure time to X ray, the patientswith screw canal penetrated the articular cartilage were recorded. During12-month follow up, complications were recorded and the Constant andMurley score was used for the assessment of all patients in the12th month.Statistics analysis were made for all indexes.Results: Between the two groups, operation time (110.55±9.36min vs.107.55±8.22min, P=0.22）and peri-operative bleeding (156.50±33.13m vs.146.50±29.78ml, P=0.32) indicated no statistical differences. Exposure timeto X ray (13.15±2.13s vs.11.50±1.73s, P=0.01) and the patients with screwcanal penetrated the articular cartilage (6vs.0, P=0.03) show significantstatistical differences, sounding method showed the absolute advantage.During the12-months follow up, no one had nonunion. In the traditionalgroup,1case had humeral head necrosis,1case had screw loosening,2caseshad screw penetration. In the sounding group,2cases had screw loosening,1case had subacromial impingement. Complication between two groups hadno statistical differences. In the12th month, the score of traditional groupwas76.30±8.69, including2excellent,13good,4poor,1bad; the score ofsounding group was77.05±7.73, including3excellent,13good,4poor. The score (P=0.78) and choiceness (P=1.00) showed no statistical differences.Conclusion: In this study, given the characteristics of osteoporosis,sounding method was used to get the accurate depth of locking screws tohumeral head. Without cockamamie adjustments in traditional method, itcould easily make the screw-tip adjoin the subchondral bone and effectivelykeep the articular surface of humeral head intact. Sounding methodsignificantly decreased the risk of exposure to X ray, and had likely trend ofcutting down the operation time, decreasing the peri-operative bleeding,reducing the risk of humeral head necrosis, screw penetration and improvingthe outcome. So, in the treatment with locking plate for proximal humeralfractures of osteoporotic patients, sounding method creates conditions for asuccessful operation. |
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