Long-term effect of open reduction and internal fixation and one stage rotator cuff repair in treatment of proximal humeral fractures combined with rotator cuff tear / 中华创伤杂志

ABSTRACT

Objective:To investigate the long-term effect of open reduction and internal fixation and one stage rotator cuff repair in treatment of proximal humeral fractures combined with rotator cuff tear.Methods:A retrospective case series study was performed on clinical data of 40 patients with proximal humeral fractures combined with rotator cuff tear admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to December 2015. There were 24 males and 16 females, aged 52-93 years [(72.5±10.2)years]. According to Neer classification, there were 7 patients with two-part proximal humerus fractures, 27 with three-part proximal humerus fractures and 6 with four-part proximal humerus fractures. All patients received open reduction and internal fixation using locking plates and one stage rotator cuff repair. Functional shoulder exercises were carried out after operation. Fracture healing and wound healing were observed postoperatively. Shoulder active motion, visual analogue score (VAS) and University of California at Los Angeles (UCLA) shoulder rating scale were assessed and compared before operation and at the last follow-up.Results:All patients were followed up for 4.5-8.5 years [(6.2±1.2)years]. All wounds and fractures healed without infection or nonunion. At the last follow-up, the active forward elevation of affected shoulder was 100°-150° [(121.8±15.8)°], the external rotation with the shoulder in neutral position was 30°-80° [(47.0±15.9)°], the external rotation with the shoulder abduction was 60°-80° [(73. 5±6.2)°], the internal rotation with the shoulder abduction was 60°-80° [(70.5±7.1)°], showing significant differences compared to preoperative 30°-60° [(44.8±11.1)°], 0°-30° [(12.0±10.4)°], 0°-30° [(13.8±7.7)°], 30°-60° [(47.0±8.5)°], respectively (all P<0.01). The VAS was 1 (0, 1)points at the last follow-up, and was 6(5, 6)points before operation ( P<0.01). The UCLA shoulder rating scale was 28-35 points [(31.0±2.3)points] at the last follow-up, compared with preoperative 8-11 points [(10.3±0.8)points] ( P<0.01), and rated as excellent in 10 patients, good in 23 and poor in 7, with the excellent-good rate of 83%. Conclusion:For patients with proximal humeral fractures combined with rotator cuff tear, open reduction and internal fixation and one stage rotator cuff repair can significantly restore the shoulder motion, relieve the pain and recovery shoulder function, and the long-term therapeutic effect is satisfactory.