[Minimally invasive percutaneous plate osteosynthesis technique for treatment of Neer II, III parts fracture of proximal humerus]

Ping Jiang, Peng Wei, Lu Chen, Xianxue Xia
Chinese Journal of Reparative and Reconstructive Surgery 2011, 25 (11): 1330-4

OBJECTIVE: To evaluate the clinical significance of minimally invasive percutaneous plate osteosynthesis (MIPPO) applied in Neer II, III parts fractures of proximal humerus.

METHODS: The clinical data were retrospectively analyzed, from 30 patients with Neer II, III parts fractures of proximal humerus in accordance with selection criteria, who were treated with manual reduction and plaster external fixation (11 cases, non-operative group) or with MIPPO (19 cases, operative group) between January 2008 and May 2010. In non-operative group, there were 6 males and 5 females with an average age of 60 years (range, 56-80 years) and with an average time of 10 hours (range, 3-24 hours) between injury and reduction, including 8 cases of Neer II and 3 cases of Neer III. In operative group, there were 13 males and 6 females with an average age of 65 years (range, 45-78 years) and with an average time of 3 days (range, 1-5 days) between injury and operation, including 9 cases of Neer II and 10 cases of Neer III. There was no significant difference in gender, age, fracture type, and time from injury to operation (P > 0.05). The shoulder joint function before and after treatments was evaluated according to Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons' Form (ASES) scoring systems.

RESULTS: Thirty patients were followed up. In operative group, the follow-up time ranged from 11 to 18 months (mean, 12 months); all incisions healed by first intention with no complication of internal fixation failure, infection, or nerve injury. In non-operative group, the follow-up time ranged from 9 to 15 months (mean, 11 months). The X-ray films showed that fractures healed without humeral head necrosis in 2 groups. The bone healing time in operative group and non-operative group was (11.47 +/- 2.48) weeks and (11.82 +/- 2.44) weeks, respectively, showing no significant difference (t = 0.369, P = 0.889). The CMS score and ASES score at each time point after treatment were significantly better than those before treatment (P < 0.05); the CMS scores in operative group were better than those in non-operative group at 3 weeks, 3 months, and 1 year after treatment (P < 0.05); and the ASES score in operative group was better than that in non-operative group at 3 weeks and 3 months after treatment (P < 0.05), but no significant difference was found at 1 year after treatment (P > 0.05).

CONCLUSION: MIPPO fixation using the locking compression plate is an effective option for Neer II, III parts fractures of proximal humerus. It can provide good functional recovery of the shoulder joint so that patients can get back to their normal life as soon as possible.

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