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[Case-control study on locking plates fixation for the treatment of Neer 3-and 4-part proximal humerus fractures]
Insights
Locking plate fixation for proximal humerus fractures showed better outcomes for 3-part fractures compared to 4-part fractures. Patients with 3-part fractures experienced improved shoulder function and reduced pain after treatment.
Area of Science:
- Orthopedic surgery
- Traumatology
- Biomechanics
Background:
- Proximal humerus fractures are common injuries, with Neer 3- and 4-part classifications indicating significant displacement.
- Locked plate fixation has become a standard treatment, but comparative outcomes based on fracture complexity require further investigation.
Purpose of the Study:
- To compare the therapeutic effects of locking plates in treating Neer 3-part versus 4-part proximal humerus fractures.
- To evaluate functional recovery and complication rates associated with locked plate fixation for these fracture types.
Main Methods:
- A cohort of 64 patients with Neer 3- (n=39) and 4-part (n=25) proximal humerus fractures were treated with locked plate fixation.
- Data collected included American Shoulder and Elbow Surgeons (ASES) scores, Visual Analogue Scale (VAS) pain scores, and complication rates.
- Follow-up ranged from 12 to 30 months (mean 16.5 months).
Main Results:
- Patients with 3-part fractures demonstrated significantly better shoulder function recovery (ASES score: 76.14 vs. 65.93, P < 0.05) and lower VAS pain scores (2.12 vs. 3.90, P < 0.05) compared to those with 4-part fractures.
- While complication rates were higher in the 4-part group (36.00% vs. 20.51%), this difference was not statistically significant.
- All patients achieved initial incision healing.
Conclusions:
- Locked plate fixation yields superior clinical outcomes for Neer 3-part proximal humerus fractures compared to 4-part fractures.
- Satisfactory outcomes in complex proximal humerus fractures are achievable with meticulous surgical technique, including anatomic reduction, stable fixation, and appropriate postoperative rehabilitation.
Objective:
To compare therapeutic effects of locking plates for the treatment of Neer 3-and 4-part proximal humerus fractures.
Methods:
From January 2009 to June 2011, 64 patients with Neer 3-and 4-part proximal humerus fractures were treated with locked plate fixation. There were 39 patients in the 3-part group including 16 males and 23 females, with an average age of (55.12 +/- 12.52) years old; and 25 patients in the 4-part fractures group including 9 males and 16 females,with an average age of (57.92 +/- 13.14) years old. The American Shoulder and Elbow Surgeons score (ASES), visual analogue scale (VAS) and complications were documented for analysis before and after treatment.
Results:
All the patients had incision healing at the first stage. All the patients were followed up, and the duration ranged from 12 to 30 months, with a mean of 16.5 months. Comparably better shoulder function recovery was achieved in the 3-part fractures group with regard to the ASES (76.14 +/- 14.10 in the 3-part fractures group vs. 65.93 +/- 11.82 in the 4-part fractures group, P < 0.05). Moreover,a statistical difference (P < 0.05) was observed regarding the VAS pain score (2.12 +/- 1.63 in the 3-part fractures group vs. 3.90 +/- 2.21 in the 4-part fractures group). For the complications rate,no statistical difference was noted between 3-part fractures group and 4-part fractures group (20.51% vs. 36.00%).
Conclusion:
The clinical outcomes of the 3-part proximal humerus fractures is better than the 4-part fractures proximal humerus fractures treated with locking plate. Complex proximal humeral fractures treated with locking plates can be achieved a satisfactory outcome when attention is paid to anatomic reduction, stable fixation, proper screws and plate placement, and reasonable functional exercise postoperative.
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