Locking Plate Fixation Combined With Artificial Bone For Treatment Of Neer 3-and 4-part Fractures Of Proximal Humeral Fractures

Objective:To investigate the clinical effects of locking plates combined with artificial bone implantation on comminuted proximal humeral fractures.Methods:A retrospective study was conducted in of 35 patients with Neer3-or 4-part fracture of humeral who had been admitted in orthopaedic department from Apr.2018 to Apr.2019 in our hospital.0f them,18 aged 50-80 years,with an average age of 64.6years were treated by locking plates combined with artificial bone allograft(group A)including 7 males and 11 females and 17 aged 50-80 years,with an average age of64.6 years by locking plates alone(group B)including 8 males and 9females.According to the Neer classification,12 cases were 3-part fractures and 64-paIt fractures in group A,10 cases were 3-part fractures and 7 4-paIt fractures in group B.Immediate postoperative radiologic findings were compared with those of 3months or more after the surgery.At the last follow-up,the imaging data were used to detect the fracture healing,shoIllder joint activity,measure the neck-shaft ang1 e and the height of humeral head,and loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle(NSA)was more than 5° or if the change of humeral head height(HHH)was more than 3 mm.Disability of Arm,Shoulder and Hand(DASH)and the Neer score were used to evaluate the function of the shoulder after surgery.Results:All patients were followed up for 6 months to 12 months,with an average of 7.4months.In the locking plate-only group,12 of 17 patients(70.6%)showed the change in NSA of more than 5°,with an average of 10.2°.The HHH change in 11 patients(64.7%)was more than 3 mm,with an average of 3.6 mm.Among 18 patients who underwent locking plate with the endosteal strut allograft,the average NSA and HHH change was 2.6° and 2.2 mm,respectively.The HHH change was more than 3 mm in2 patient(11%).The average DASH score of group A was 18.6 points,and the average DASH score of group B was 20.2 points.The Neer score of group A was used to evaluate the shoulder function: 8 cases were excellent,6 cases were good,3 cases were fair,and 1 case was poor in this study.The excellent and good rate is 77.8%.The Neer score of group B was used to evaluate the shoulder function: 4 cases were excellent,6 cases were good,5 cases were fair,and 2 case was poor in this study.The excellent and good rate is 58.8%.Patients in group A were superior to group B in terms of neck-shaft angle,humeral head height changes,DASH and Neer score.The difference between the 2 groups were all statistically significant(P<0.05).Conclusion:The treatment that of locking plate fixation combined with artificial bone of Neer 3-and 4-part fractures of proximal humeral fractures can effectively stabilize displaced fractured blocks and eliminate bone defects and enhance the support of the medial column of the proximal humerus,which can significantly reduce postoperative internal fixation failure such as screw loosening,cutting and other complications.