Résumé
Objective To explore the clinical application and follow-up results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treating proximal humeral fractures. Methods From December 2006 to September 2008, MIPPO using locking plate was employed to treat 36 patients (23 males and 13 females) with proximal humeral fracture. According to AO classification, there were four patients with type A2 fractures, 10 with type A3 fractures, five with type B1 fractures, 11 with type B2 fractures, three with type C1 fractures and three with type C2 fractures. Longitudinal or transverse incision was made through anterolateral acromial approach to separate the deltoid muscle and expose the fracture fragments. The direct and indirect reduction of the fractures were performed under direct vision. The locking plate was inserted distally beneath the deltoid muscle and a longitudinal incision was made at the lateral end of the plate. Locking screws were inserted to the proximal and distal plates. Postoperative follow-up was done to provide guidance to functional exercise and evaluate the clinical results. Results The operation lasted for (50.1±11.3) minutes, with intra-operative blood loss of(76±18.7) ml and average operative incision of (4.5±0.8) cm. All the patients were followed up for 12-17 months (average 14 months), which showed that the time of bone healing was (10. 1 ±1.2) weeks. Neer scoring standards showed the total excellence rate of 86%. Conclusion MIPPO is an ideal method for treatment of proximal humeral fractures, for it has the advantages such as safety, minor trauma, short bone healing time, alleviation of pain and good X-ray reduction.
Résumé
Objective To summarize the clincal effect of open reduction and internal fixation with locking-proximal-humerus-plate(LPHP)to treat proximal humeral fractures.Methods A total of 19 eases with proximal humeral fractures were treated with LPHP from August 2003 to February 2006 in this study.Their mean age was 58.6 years old.According to Neer classification,two cases were with two- part fractures,nine with three-part fractures and eight with four-part fractures including seven cases with osteoporosis.Redaction and fixation was done via deltopeetoral-groove approach.Bone graft was applied for five eases.Results The follow-up period was 3 to 32 months(mean 17 months).All cases were healed and the union period of 3-5 months.According to the Near shoulder score,the results showed that ten cases were excellent,6 cases good,with excellent rate of 84%.Conclusion The LPHP method is suitable for osteoporosis and comminuted proximal humeral fractures and enhances the treatment effect.
Résumé
Objective To discuss the treatment effect of locking-proximal-humerus-plate (LPHP) for three- or four-part proximal humeral fractures. Methods A retrospective study was done on 13 cases of proximal humeral fractures treated with LPHP from July 2003 to January 2005. There were six males and seven females, with age of 24-73 years (mean 49.8 years). According to Neer classification, five cases were with three-part fractures and eight with four-part fractures including six cases with osteoporosis. Reduction and fixation was done via deltopectoral-groove approach, without cutting the capsule or peeling the soft tissues of the greater and lesser tuberosity. Of all, three cases with bone defects was treated with allografts. Shoulder exercise could be performed passively three days after operation. One week after operation, passive and active shoulder exercise was done, which was gradually intensified two weeks after operation. Results A follow up for 3-20 months (average 11 months) on 12 cases showed that all fractures were healed. According the Neer shoulder score, the results was excellent in six cases, good in four and fair in two, with excellence rate of 83.3%. Conclusions The screw of LPHP can lock the plate so that the plate can firmly fixate the fractures without tightly contacting the bone, as simultaneously reaches fracture healing and function exercise and enhances the treatment effect. LPHP is a specially suitable procedure for osteoporosis and three-or four-part proximal humeral fractures.