Curative effect of anatomic plate internal fixation for complex proximal humeral fractures combined with humeral shaft fractures

Abstract

Objective To investigate the efficacy of anatomic plate internal fixation in treatment of complex proximal humeral fractures combined with humeral shaft fractures. Methods This retrospective case series study included 58 patients with complex proximal humeral fractures combined with humeral shaft fractures admitted from July 1998 to July 2015. There were 31 males and 27 females, with a mean age of 63 years (range, 18-86 years). According to the Neer classification of proximal humeral fractures, three-part fractures were noted in 42 patients and four-part fractures in 16 patients. Four patients were combined with compressed or splitting fractures of the head of humerus and 38 patients with dislocation of the shoulder. According to the site classification of femoral shaft fractures, proximal 1/3 shaft fractures were noted in 36 patients, middle and distal 1/3 shaft fractures in 19, and multisegmental shaft fractures in three. All patients underwent anatomic reduction and anatomic plate internal fixation. Bone healing, Neer score of function outcome and complications were evaluated after operation. Results Mean duration of follow-up was 8.6 years (range, 1-18 years). Bone union was observed in all patients after 10 to 24 weeks (mean, 14.5 weeks). According to the Neer score, the outcomes were excellent in 23 patients, good in 25, fair in eight and poor in two, with the excellent rate of 83%. Complications such as infection, nerve injury and vascular injury were not observed after operation. Six patients suffered from limitations of shoulder anterior flexion and rise, one patient had humeral head necrosis and treated by shock wave treatment, and one patient had poor incision healing with hemorrhagic effusion and cured after dressing. Conclusion Anatomic plate internal fixation can contribute to fast functional recovery and few complications in treatment of complex proximal humeral fractures combined with humeral shaft fractures. Key words: Humeral fractures; Fracture fixation, internal; Reduction