A Comparative Study Of Multiloc Intramedullary Nail And Locking Plate In The Treatment Of Proximal Humeral Fractures

Objective: The incidence of fracture of proximal humerus is second only to fracture of hip and distal radius,which is about 5%.Among them,the incidence rate of women over 60 years old is more than 70%.And most of the patients are accompanied with osteoporosis[1,2,3].The current clinical treatment of proximal humeral fractures in general can be divided into conservative treatment and surgical treatment,for simple non-displaced fractures,conservative treatment can be selected.however,for severely separated and displaced fractures of the broken end of the bone,the affected limb needs to be fixed for a long time after conservative treatment,which can easily lead to shoulder stiffness and other related dysfunction,and it is hard to get satisfactory recovery results.Therefore,most of them were treated with surgical internal fixation[4].At present,there are different opinions on how to choose many kinds of internal fixation instruments for proximal humerus,such as external fixator,Kirschner wire,tension band,locking plate and intramedullary nail.but now the clinical mainstream is still locking plate and intramedullary nail[5].Therefore,we followed up the recovery of patients with proximal humeral fracture before and after operation,studied and compared the short-term and long-term shoulder function recovery after treatment with different internal fixation materials,and compared and evaluated the curative effect.in order to provide help for the relevant clinical treatment decisions.Methods: From September 2017 to September 2019,42 patients with proximal humeral fracture in orthopaedics department of trauma were selected.Neer fracture classification was used.23 patients in the locking plate group and 19 patients in the Multiloc proximal humeral intramedullary nail group were treated with conventional deltoid interpectoralis major sulcus approach and anterolateral acromial approach,respectively.The perioperative data of the two groups were compared and analyzed.Using Constant-Murley shoulder function score[17]system to analyze and evaluate shoulder function recovery of patients with various fracture types at 6 weeks,3months and 12 months after operation.The evaluation of shoulder joint function at 6weeks,3 months and 12 months after operation could reflect the short-term and long-term recovery of shoulder function between the two groups,taking P < 0.05 as the data difference with statistical significance.Results: In this study,there were 23 patients in locking plate group,including two-part,three-part and four-part fractures in 11-7-5,with an average age of 67.57±9.967 years,and 8-6-5 in 19 patients in Multiloc intramedullary nail group,with an average age of 68.95 ±14.285 years.The length of incision,operation time,intraoperative blood loss,postoperative incision healing time and hospital stay in Multiloc intramedullary nail group were significantly better than those in locking plate group,but there was no significant difference in VAS pain score between locking plate group and locking plate group 1 week after operation.The comparison of postoperative shoulder function recovery follow-up data showed that the Constant-Murley score of Multiloc intramedullary nail group was significantly better than that of locking plate group 6 weeks after operation,and there was no significant difference in long-term shoulder function recovery between Multiloc intramedullary nail group and locking plate group at 6 weeks after operation.However,there was no significant difference in postoperative Constant-Murley score between Multiloc intramedullary nail group and locking plate group by comparing the postoperative shoulder function data of patients with Neer classification of four-part fracture.Conclusion: Proximal humeral fractures treated with Multiloc intramedullary nails can reduce the length of the surgical incision,save operating time,reduce intraoperative bleeding,postoperative incision healing time and hospital stay.For the patients with proximal humeral fractures classified by Neer classification,the early shoulder function recovery after treatment with Multiloc intramedullary nail is faster than that with locking plate,but there is no significant difference in long-term shoulder function recovery.However,there was no significant difference in shoulder joint function between Multiloc intramedullary nail and locking plate in patients with proximal humeral fracture according to Neer classification.In clinical decision-making,it is necessary to comprehensively analyze the individual differences of different patients and choose the best diagnosis and treatment scheme.