Three surgical treatments of two-part humeral proximal fractures in the elderly patients

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Objective To compare humeral intramedullary nailing (HIN),open reduction and internal fixation (ORIF) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of two-part humeral proximal fractures in the elderly patients. Methods From January 2006 to December 2009,49 patients with fracture of humeral surgical neck were treated by HIN,ORIF and MIPPO.They were 12 men and 37 women,with an average age of 65.7 years (from 54 to 71 years).There were 18 cases in group A (HIN),12 in group B (ORIF) and 19 in group C (MIPPO).The preoperative conditions,fracture healing,complications and functional recovery were compared between the 3 methods. Results All the 49 patients were followed up for 8 to 36 months (average,17.8 months).The mean incision length was 7.1 ±0.3 cm in group A,13.7 ±0.9 cm in group B and 12.1 ±0.8 cm in group C; the mean operative blood loss was 58.3±20.7 mL in group A,283.3 ±44.4 mLin group B and 96.3±9.0 mL in group C.There were significant differences between the 3 methods(P ＜ 0.05).The HIN had the shortest incision and the least operative blood loss.In the mean operative time,HIN[(90.5 ± 18.5) min] was signifieandy better than ORIF [[( 111.3 ± 16.7 ) min] and MIPPO[( 112.4 ± 9.9) min] ( P ＜ 0.05).There were no significant differences in the fracture healing time and functional recovery between the 3 groups ( P ＞ 0.05 ). Conclusions Although the 3 methods can produce similar efficacy in the treatment of two-part humeral proximal fractures in the elderly patients,the humeral intramedullary nailing has an advantage over the other two in operative invasion and operative time. Key words: Humeral fractures, proximal; Fracture fixation, internal; Bone plate