Clinical Analysis Of Open Reduction And Internal Fixation In The Treatment Of Severe Proximal Humeral Fractures

Objective:To investigate the clinical effect of open reduction and internal fixation in the treatment of severe proximal humeral fractures.Methods:The data of 32 patients with severe proximal humeral fractures treated by open reduction and internal fixation in our department from January 2017 to June 2020 were analyzed retrospectively.There were 12 male patients and 20 female patients,aged from 25 to 85 years old,with an average of(61.34±16.16)years.According to Neer classification,there were 21 cases of 4-part fracture,including 2 cases of shoulder dislocation,1 case of anatomical neck and humeral head fracture,and 11 cases of Neer classification of 3-part fracture with osteoporosis.All patients in this group were treated with high-quality open reduction and internal fixation,that is,surgical exposure with as little collateral injury as possible,anatomical reduction or approximate anatomical reduction,firm and reliable internal fixation.The operation time,intraoperative blood loss,intraoperative bone graft and or use of medial supporting titanium plate,incision length,postoperative discharge time,postoperative complications and fracture healing time were recorded.According to postoperative X-ray and CT,the screw was pierced through the articular surface,the cervical shaft angle,the position of large tubercle and the position of titanium plate were calculated.Shoulder joint function was evaluated according to Constant-Murley score at the 12 th month after operation.Results:The average operation time,intraoperative blood loss,incision length,postoperative discharge time and fracture healing time of 32 patients were(102.34 ±39.98)min,(174.38 ±100.54)m L,(15.13 ±3.23)cm,(8.10 ±3.95)days and(84.91 ±11.50)days,respectively.The fracture healing rate was96.9%.Among them,14 patients were treated with allogeneic bone graft,3patients with autogenous iliac bone graft and medial supporting titanium plate.Postoperative complications occurred in 2 cases(6.25%),including 1 case of humeral head necrosis and 1 case of delayed fracture healing.There was no screw passing through the articular surface after operation,and the cervical trunk angle,the position of large nodule and the position of titanium plate did not change twice after operation(P > 0.05).At the 12 th month after operation,the Constant-Murley score was 55.92,with an average of 81.19 ±8.67.the results were excellent in 20 cases,good in 8 cases,fair in 3 cases and poor in1 case.the total excellent and good rate was 87.5%.Conclusion:For severe proximal humeral fractures,high-quality open reduction and internal fixation is used,that is,surgical exposure of accessory injury as little as possible,anatomical reduction or approximate anatomical reduction,firm and reliable internal fixation.Combined with good and standard early rehabilitation exercise of shoulder joint function after operation,satisfactory clinical effect can be obtained.