Locking plate combined with allogenic fibular intramedullary support for elderly patients with varus proximal humeral fracture / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical outcomes of locking plate combined with allogenic fibular intramedullary support in the elderly patients with varus proximal humeral fracture.Methods From May 2015 to July 2017,21 elderly patients with varus proximal humeral fracture were treated with locking plate combined with allogenic fibular intramedullary support at Department of Orthopaedics,The Second Clinical Medical College,Guangzhou University of Traditional Chinese Medicine.They were 6 men and 15 women,from 65 to 90 years of age (average,74.8 years).According to the Neer classification,2-part fracture was identified in 2 patients,3-part fracture in 14 and 4-part fracture in 5.Their operation time,amount of intraoperative bleeding,postoperative complications and functional scores at the last follow-up were recorded.The humeral neck angles and humeral head heights were compared between preoperation,postoperation and the last follow-up.Results Their operation time averaged 89.5 minutes (from 70 to 110 minutes) and intraoperative bleeding 179.5 mL (from 160 to 400 mL).They obtained follow-up from 12 to 26 months (average,18.1months).All the wounds were healed by the first intention.No such complications occurred as neurovascular lesion,shoulder dislocation or humeral head necrosis.However,screw cut-out was observed in one case.According to the Neer's scoring system,shoulder function was evaluated at the last follow-up as excellent in 3cases,as good in 15 and as fair in 3,giving a good to excellent rate of 85.7％.The humeral neck angle after operation was 136.4° ± 5.8°,significantly larger than the preoperative one (106.0° ± 7.3°) (P ＜0.05) but insignificantly different from the value at the last follow-up (135.4° ±6.5°) (P ＞ 0.05).The postoperative distance between the plate top and the humeral head top was 1.6± 0.2 mm,insignificantly different from that at the last follow-up (1.5 ± 0.2 mm) (P ＞ 0.05).Conclusion Locking plate combined with allogenic fibular intramedullary support can effectively reconstruct the medial proximal column of the humerus,restore the humeral neck angle,facilitate intraoperative fracture reposition and reduce operation time,leading to good functional recovery of the shoulder and prevention of related complications.