Treatment of comminuted fractures of the proximal humerus with locking proximal humeral plate

Abstract

Objective To evaluate the efficacy of locking proximal humeral plate (LPHP) for the treatment of comminuted fractures of proximal humerus in comparison with anatomical proximal humeral plate (APHP) and T-shaped plate.Methods From August 2008 to September 2010,65 patients with comminuted fracture of proximal humerus of Neer types Ⅱ-Ⅳ were treated in our department.They were 36 men and 29 women,with an average age of 39 years (from 24 to 70 years).LPHP was used in 36 patients (group A),APHP in 19 patients (group B) and T plate in 10 patients (group C).All the operations were conducted through the deltoid-pectoral-gap,and autografts were transplanted in the cases of bone defects after reduction.Exercises were done 1 to 6 weeks postoperation to prevent shoulder anchylosis.The clinical outcomes were compared between the 3 methods,including fracture healing,Neer score and complications.Results All the patients were followed up from 12 to 18 months (14.5 months on average).Fracture union was achieved in 36 cases in group A,in 17 cases in group B and in 8 cases in group C,with significant between-group differences ( P ＜ O.05).The mean healing time was 10.1 ± 1.2 weeks in group A,12.3 ± 1.4 weeks in group B and 15.4 ±2.6 weeks in group C,with significant between-group differences ( P ＜ 0.05).Humeral head necrosis occurred in 2 cases in group B and in 2 cases in group C,with a significant difference between group A and groups B and C ( P ＜ 0.05).By Neer scoring system,the good to excellent rate of shoulder function was 97.2％ in group A,63.2％ in group B and 40.0％ in group C,with significant between-group differences ( P ＜ O.05).Conclusion LPHP can be considered as the standard-therapy for comminuted fractures of proximal humerus of Neer types Ⅲ - ⅣV,because it can firmly fixate the comminuted fractures of the proximal humerus,leading to fast fracture healing,good functional recovery and limited complications. Key words: Shoulder fractures; Fractures, comminuted; Fracture fixation, internal; Bone plates