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KMID : 0361620110460050372
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Journal of the Korean Orthopaedic Association
2011 Volume.46 No. 5 p.372 ~ p.379
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A Comparative Study of Three Different Fixation Techniques for Displaced Two- and Three-Part Proximal Humeral Fractures
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Cheon Sang-Jin
Lee Ji-Min
Lee Jung-Sub
Kim Hui-Taek
Suh Jeung-Tak
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Abstract
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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 yea rs 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 l, 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 lock ing compression plate were useful surgical methods for displaced two- and three-part proximal humeral fractures.
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KEYWORD
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proximal humerus, two- and three-part fractures, closed reduction and percutaneous pinning, bifurcated plate and tension band wiring, locking compression plate
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