Abstract:
Background Proximal humeral fracture is a common fragility fracture in geriatric patients, reconstruction of medial column stability is the key to the treatment, but there are differences in reconstruction methods.
Objective To compare the curative effect of novel anatomical intramedullary support system versus locking plate combined with autologous ilium crest graft in the treatment of elderly patients with proximal humerus fractures.
Methods A retrospective analysis was performed in the elderly patients with three- and four-part fractures of the proximal humerus admitted to the Department of Orthopaedic Medicine, Chinese PLA General Hospital from September 2018 to June 2021. According to different treatment methods, the patients were divided into observation group and control group. Patients in the observation group were treated with a novel anatomical intramedullary support system, while the control group was treated with locking plate combined with autologous ilium crest graft. The operation time, intraoperative blood loss, incision length, reduction quality, pain visual analog scale (VAS), Constant-murley score, DASH (disability of the arm, shoulder, and hand) score and complications at the last follow-up were compared between the two groups.
Results There were 47 cases with proximal humerus fractures, including 25 cases of three-part fracture and 22 cases of four-part fracture by Neer classification. Twenty-two cases were in the observation group and 25 in the control group, and there was no significant difference in general information between the two groups (all P＞0.05). The mean follow-up time was 18.4 months, and all patients achieved bone healing. In the observation group, the incision length (6.43 ± 0.78 cm vs 10.74 ± 0.81 cm), intraoperative blood loss (192.27 ± 55.02 mL vs 250.00 ± 57.80 mL), operation time (101.27 ± 13.80 min vs 116.72 ± 11.24 min) were all less than those of the control group (all P＜0.05). The change value of the neck-shaft angle in the observation group was less than that of the control group (0.71 ± 0.63° vs 3.2 ± 1.14°, P＜0.05). There were no significant differences in VAS pain score, Constant-murley score and DASH score between the two groups at the last follow-up (P>0.05).
Conclusion Compared with the locking plate combined with autologous ilium crest graft group, the novel anatomical intramedullary support system group has the advantages of less damage and stronger ability to maintain reduction.
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