Open reduction and internal fixation versus minimally invasive percutaneous plate osteosynthesis for complicated proximal humeral fractures

Abstract

Objective To compare open reduction and internal fixation(ORIF)and minimally invasive percutaneous plate osteosynthesis(MIPPO)in the operative treatment of complicated proximal humeral fractures. Methods From January 2014 to October 2015, 55 complicated proximal humeral fractures were treated at our department. They were 32 men and 23 women, from 21 to 81 years of age(average, 51 years). According to Neer classification, 34 cases belonged to three-part fractures and 21 ones to four-part fractures, 14 of which were complicated with dislocation. Of them, 35 received ORIF and 20 underwent MIPPO. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length and Neer scoring of the shoulder function at the final follow-ups. The 2 groups were compatible without significant differences in preoperative demographic data(P> 0. 05). Results The 55 patients were followed up for 6 to 12 months(mean, 9 months). The operation time(100. 5 ±10. 2 min), intraoperative blood loss(80. 0 ±10. 5 mL), and incision length(7. 5 ±3. 2 cm)in the MIPPO group were significantly better than those in the ORIF group(120. 0 ±10. 1 min, 200. 5 ±10. 2 mL, and 10. 5 ±5. 3 cm, respectively)(P< 0. 05). According to the Neer scoring of the shoulder function at the final follow-ups, the good to excellent rate was 71. 4%(25/35)in the ORIF group and 85. 0%(17/20)in the MIPPO group, showing a significant difference(P< 0. 05). The incidence of humeral head necrosis was 15 in the ORIF group, significantly higher than that(3)in the MIPPO group(P< 0. 05). Conclusion In treatment of complex proximal humeral fractures, compared with ORIF, MIPPO may lead to less damage to local blood supply, less trauma, and quicker functional recovery due to early functional exercise. Key words: Shoulder fractures; Surgical procedures, minimally invasive; Fracture fixation, internal