Internal fixation for treatment of severe proximal humeral fracture-dislocation in young adults

Abstract

Background Proximal humeral fracture accounts for about 5% of all fractures, and epidemiological studies in China have shown that proximal humeral fracture accounts for 13.5% of hospitalized patients with periarticular fracture. However, the cases of severe proximal humeral fracture combined with humeral head dislocation are rare in clinical practice. For elderly osteoporosis patients with severe proximal humeral fracture and humeral head dislocation, it is currently accepted that shoulder arthroplasty is preferred. But for young adults, the choice of surgical methods is often controversial. Due to the complex type of proximal humeral fractures and special anatomical structure, the operative manipulation of open reduction and internal fixation as well as humeral head preservation is difficult. There are a series of postoperative complications such as plate breakage, nail withdraw, screw penetration, infection, etc., and high incidence of humeral head necrosis is reported in the literatures, which has always been a major challenge for surgeons of shoulder and elbow trauma. Objective To investigate the clinical efficacy of locking plate internal fixation for treatment of severe proximal humeral fracture-dislocation in young adults. Methods From June 2012 to June 2017, 24 patients (15 males and 9 females) with severe proximal humeral fracture-dislocations were treated in our hospital, and the clinical data were retrospectively analyzed. The ages ranged from 31-59 years with an average age of 39.2 years. There were 8 right-sided cases and 16 left-sided cases. All the fractures were fresh, and according to Neer classification, there were 6 three-part cases and 18 four-part cases. Twenty one cases were anterior dislocations, and 3 cases were posterior dislocations. The operation time, intraoperative blood loss, and hospitalization duration were recorded, and the incision healing, fracture healing and postoperative complications were observed. The shoulder function was evaluated by Neer scoring system in the last follow-up. Results The patients were followed up for 12 to 37 months, with an average of 19.7 months. The operation time was 69-113 minutes with an average of 82.3 minutes. The intraoperative blood loss was 100-500 ml with an average of 197.5 ml. The hospital stay was 6 to 14 days with an average of 8 days. All the incisions healed at the first stage. At the last follow-up, 21 patients had clinical healing, 1 patient was found to have infection half a year after operation and treated with humeral head replacement at the secondary stage, and 2 patients developed humeral head necrosis but refused further treatment. The postoperative range of anterior flexion was 82°-165° with an average of 136°, the postoperative range of backward flexion was 20°-45° with an average of 40°, the range of abduction was 87°-170° with an average of 147°, and the range of internal rotation was L5 to T9. There was statistical significance between the postoperative ranges of motion and the preoperative ones (P<0.05) . According to Neer scoring system, there were 8 excellent case, 11 good cases, 4 moderate cases, and 1 poor case. The overall excellent and good rate was 79.17%. Conclusions For the treatment of severe proximal humeral fracture-dislocation in the young patients with locking plate internal fixation, the clinical efficacy is better, which is also a treatment option. Key words: Proximal humerus; Fracture-dislocation; Locking plate; Internal fixation