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[Case-control study on minimally invasive percutaneous new plate osteosynthesis applied in proximal humerus fractures
Jie Liu1, Shao-Hua Li, Zheng-Hua Li
1Department of Orthopaedics, the 10th People's Hospital of Shanghai, Shanghai Tongji University, Shanghai 200072, China.
Objective:
To evaluate the clinical significance of minimally invasive percutaneous new plate osteosynthesis (MIPPO) applied in three and four-part fractures of proximal humerus in elder patients.
Methods:
From June 2008 to December 2010, 98 old patients with three and four-part fractures of proximal humerus were treated with locking plate osteosynthesis. There were 43 males and 55 females with an average age of (71.3 +/- 6.2) years ranging from 65 to 84. Among them,47 cases were treated with minimally invasive percutaneous new plate osteosynthesis (MIPPO) through antrolateral transdeoltoid approach, and meanwhile 51 cases were treated with open reduction and internal fixation (ORIF) through a traditional deltopectoral approach. The operation time,blood loss,wound complications and hospital stay were recorded. The functional outcomes of the shoulder were assessed according to Constant score.
Results:
Ninety-six patients were followed up for 13 to 42 months (averaged 18.1 months),and 2 patients died during the follow-up period. The mean blood loss of the MIPPO group was lower than that of the ORIF group by 125 ml (P < 0.05). There was no difference in the operation time between two groups. But the MIPPO group had a slightly shorter hospital stay than the ORIF group (P < 0.05). All the fractures united clinically and radiologically. The difference of the mean healing time between two groups was not significant. The mean Constant score at final follow-up of two groups had no statistic difference. But the rate of complication of the MIPPO group was lower than that of the ORIF group (P < 0.05). Only 1 case of the MIPPO group had axillary nerve paralysis post-operatively, but 4 cases had slack internal fixation and 2 cases had avascular necrosis of the humeral head in the ORIF group.
Conclusion:
The technique of percutaneous insertion combined new locking plate internal fixation has the advantages of less blood loss, rapid recovery, less vascular damage, lower risk of complications and so on. It can effectively treat the proximal humerus three-and four-part fractures, especially to elder patients with osteoporosis.