A comparative study of three internal fixation techniques for comminuted fractures of humeral greater tuberosity / 中华创伤骨科杂志

ABSTRACT

Objective:To compare the clinical outcomes between anatomical locking plate, proximal humerus internal locking system (PHILOS) and anatomical locking plate combined with suture anchors in the treatment of comminuted fractures of humeral greater tuberosity.Methods:A total of 33 comminuted fractures of humeral greater tuberosity were surgically treated from October 2016 to October 2021 at Department of Orthopedics, Tongji Hospital Affiliated to Tongji University. There were 20 males and 13 females, with an age of (53.5±13.6) years. They were assigned into 3 groups according to different internal fixation techniques. Group A of 12 cases was subjected to fixation with anatomical locking plate via the deltoid approach, group B of 10 cases subjected to fixation with PHILOS via the pectoralis major and the deltoid approaches and group C of 11 cases subjected to fixation with anatomical locking plate combined with suture anchors via the deltoid approach. The operation time, intraoperative blood loss, range of shoulder motion, Constant-Murley shoulder score, visual analogue scale (VAS) and postoperative complications were compared between the 3 groups.Results:The 3 groups were comparable because there was no significant difference between them in the general clinical data ( P>0.05). The follow-up duration for all patients was (14.5±4.1) months. All fractures got united at the last follow-up. In groups A, B and C, respectively, the operation time was (57.9±7.8), (73.0±7.1) and (63.6±9.5) min, and the intraoperative blood loss (41.7±18.9), (82.0±22.9) and (46.4±13.6) mL, showing significant differences between the 3 groups ( P<0.05). The operation time and intraoperative blood loss in groups A and C were significantly less than those in group B ( P< 0.05). At the last follow-up, in groups A, B and C, respectively, the shoulder abduction was 144.0°±7.7°, 138.7°±10.7° and 148.5°±6.2°, showing significant differences between the 3 groups ( P<0.05). Group C was significantly better than group B ( P<0.05). There was no statistically significant difference in the forward flexion, external rotation, or internal rotation of the shoulder joint between the 3 groups ( P>0.05). The Constant-Murley scores in groups A, B and C, respectively, were (90.4±5.7), (86.1±6.6) and (93.1±3.4) points, showing significant differences between the 3 groups ( P<0.05). Group C was significantly better than group B ( P<0.05). The VAS scores in groups A, B and C, respectively, were 1 (0, 2), 1 (0, 2), and 1 (0, 1) point, showing insignificant differences between the 3 groups ( P>0.05). Group A had 1 case of shoulder joint stiffness and 1 case of fracture re-displacement complicated with acromial impingement syndrome, group B 1 case of shoulder joint stiffness and 3 cases of fracture re-displacement, but group C no post-operative complication. Conclusions:In the treatment of comminuted fracture of humeral greater tuberosity, all the 3 internal fixation techniques can lead to fine clinical outcomes. Conventional PHILOS may lead to relatively large trauma and a high incidence of postoperative complications. The anatomical locking plate may result in fine functional recovery of the shoulder due to advantages of less invasion, shorter operation time and fewer postoperative complications than PHILOS. The anatomical locking plate combined with suture anchors may lead to the best shoulder functional recovery and the least complications.