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Abstract
Purpose
To analyze and compare the results of three different surgical methods - closed reduction and percutaneous pinning (Group I), bifurcated plate and tension band wiring (Group II), locking compression plate (Group III), - for displaced two- and three-part proximal humeral fractures.
Materials and Methods
Sixteen patients were treated with a closed reduction and percutaneous pinning, 19 with bifurcated plate and tension band wiring and 18 with locking compression plate. All patients were followed up for more than 1 year, and were reviewed and evaluated with respect to radiological and clinical results. The radiological results were evaluated by bony union and humerus neck shaft angle using the Paavolainen method. The clinical results were evaluated by Neer's evaluation criteria.
Results
Bony union rate, time period to achieve bony union, neck shaft angle and clinical results in Groups II and III were better than those in Group I (p<0.05). There were no significant differences between Groups II and III. We observed trends for worse clinical outcomes in patients older than 65 years compared with those in patients younger than 65 years. Clinical outcome for patients older than 65 years in Group III (average 87.5 points) was better than that for the same age group in Groups I (average 77.2 points) and II (average 79.3 points), but the cohorts were too small to obtain statistical significance. Complication rate in Groups II, III was lower than that in Group I (p=0.005).
Conclusion
The radiological and clinical results in Groups II and III were significantly better than those in Group I, and there were no
significant differences between Groups II and III. We thought that bifurcated plate and tension band wiring and locking compression
plate were useful surgical methods for displaced two- and three-part proximal humeral fractures.
Figures and Tables
Figure 1
A 68-year-old woman who was treated using closed reduction and percutaneous pinning. (A) The preoperative radiograph shows displaced proximal humerus fracture. (B) The postoperative radiograph shows that three pins are passed through lateral cortex and one pin is inserted from greater tuberosity. (C) The radiograph taken at last follow up shows bony union. Patient's clinical result using Neer's criteria was good and neck shaft angle using Paavolainen's method was good.
Figure 2
A 64-year-old man who was treated using bifurcated plate and tension band wiring. (A) The preoperative radiograph shows 2-part proximal humerus fracture. (B) The postoperative radiograph shows reduction and fixation with bifurcated plate and tension band wiring. (C) The radiograph taken at last follow up shows bony union. Patient's clinical result using Neer's criteria was good and neck shaft angle using Paavolainen's method was fair.
Figure 3
A 65-year-old man who was treated using locking compression plate. (A) The preoperative radiograph shows displaced 2-part proximal humerus fracture. (B) The immediate postoperative radiograph shows adequate reduction and fixation. (C) The last follow up radiograph shows complete bone union. Patient's clinical result using Neer's criteria was excellent and neck shaft angle using Paavolainen's method was good.
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