The Study Of Humerus Surgical Neck Fracture Treatment By Keeping The Shoulder Joint Capsule Integrity

Objective: Humerus surgical neck is an important part of shoulder joint,which is the largest one on activity in human body. Shoulder joint is a typicalenarthrosis composed of humerus head and scapula glenoid cavity, the latter islittle and shallow with glenoid labrum on the margin. It is surrounded by thejoint capsule which has the long tendon of biceps brachii through inside andhas the coracohumeral ligament, coracoacromial ligament and tendon outsidestrengthen its stability. Anteria arcuata, deriving from the anterolateral branchof anterior humeral circumflex artery, and medial posterial artery, stemingfrom the posterior humeral circumflex artery supply the blood of humerushead. These arteries enter into the joint capsule from humerus surgical neck tothe humerus head. Humerus surgical neck fracture tend to damage the bloodsupplication of humerus head more easily that adverse to fracture healing,even to be humerus head necrosis, whose possibility is increased by traditionalopen reduction and internal fixation because of injuring the surrounding softtissue. Based on this, the study treated the humerus surgical neck fracture byopen reduction and keeping the shoulder joint capsule integrity simultaneously,with a view to protecting the blood supplication of humerus surgical neck. Thewhole point to all this is hoping to improve union rate and to reduce rate ofnonunion and humerus head necrosis.Methods:79patients on humerus surgical neck fracture in The ThirdHospital, Hebei medical university between December2011and December2013were included. Those who diagnosed with underlying disease such ashypertension, cardiopathy and diabetes mellitus were excluded. Case detail,intact image was recorded and post-operation follow-up was offered for eachcase. All patients were divided into two groups randomly, the control and theexperimental group, accoding to keep the shoulder joint capsule integrity or not. Operation procedure of the control group: first, incising the joint capsuleto fully expose the fracture end. Second, anatomically reducting the fracturesites under C-arm X-ray machine, then applying open reduction and internalfixation to it. The difference between two groups on operation procedure isthat we kept the joint capsule integrity after soft tissue was separated toperiosteum.Surgery method: All patients were under the Brachial plexus anesthesia.We chose the surgical approach along with spatium intermusculare ofpectoralis major and deltoid muscle. Shoulder was kept at60-degree abductionto protect the axillary nerve, after that we loosed part of the up rim of deltoidmuscle to expose fracture end and joint capsule. To begin with in controlgroup, we incised the joint capsule to fully expose the fracture, and reductedthe open fracture sites. Secondly, attaching a right locking compressionproximal humeral plate to the anterolateral humerus, then drilling andscrewing in an appropriate bolt successively. Thirdly, stepwise suturing theincision when the fracture part was determined to be well reducted underC-arm X-ray machine. Patients in experimental group were reducted thefracture under C-arm X-ray machine so that the shoulder joint capsule can bekept integrity. Other procedures were same as that mentioned above.Postoperative management: It makes sense to give patients sometreatments such as detumescense, anti-infection and hanging the limb at90-degree flexion by triangle towel. Patients were offered personal trainingscheme according to their fracture type, degree of osteoporosis and bonedefect. Isometric contraction training of shoulder muscles and initiative handand elbow were taken after two days of surgery. Patients began to motion theirshoulder joints passively after one week of surgery, and to increase the rangeof motion step by step, finally transition to shoulder pendulum motion. Takingout stitches based on the intertion status. Patients were demanded to conductactive shoulder motion. Beyond that, recovering the motion range andmyodynamia gradually in accordance with X-ray.Statistical analysis: Continuous data are expressed as mean±standard deviation. Categorical data are expressed as percentage of total. Comparisonbetween groups used student’s t-test, Mann Whitney U-test and chi-square test.All statistical significance were taken as P＜0.05and analysis were done bySPSS18.0.Results: Reexamining the adem position X-ray of humerus after1,3,6and12months of surgery respectively to determine intertion status. Shoulderjoint function was evaluated by the Constant-Murley score. A total of79patients were included.39contained in control group, the highest was97.0points, the lowest was44.0points. In this population,20.5%were consideredto recover excellently,25.6%were well to recovery,43.6%were in the middlepoints, and10.3%were not in good. The total fineness rate of shoulder jointfunction was46.2%. The highest score of joint function in experience groupwas97.0points, the lowest was44.0points. Between them,32.5%wereconsidered to recover excellently,42.5%were well to recovery,20.0%were inthe middle points, and5.0%were not in good. The total fineness rate ofshoulder joint function was75.0%. There was a significant difference ofrecovery degree in the shoulder joint function between two groups(P=0.023,0.009).Conclusion: There was a good clinical efficacy of traditional openreduction and internal fixation in humerus surgical neck fracture. However,method of keeping shoulder joint capsule integrity will be better to protect theblood supplication of humerus surgical neck which can facilitate to fractureunion, reduce nonunion rate and humerus head necrosis.