Comparison of radiographic and clinical results between MIPO internal fixation and auxiliary tension suture fixation for proximal humeral fractures

Abstract

The aim of this study was to evaluate the efficacy of auxiliary tension suture fixation and minimally invasive percutaneous osteosynthesis internal fixation on proximal humeral fractures in patients. From May 2012 to May 2017, 66 patients with proximal humeral fractures were enrolled in the Affiliated Suzhou Hospital of Nanjing Medical University. A prospective follow-up cohort study was conducted on 47 patients with proximal humeral fractures, including 11 males and 36 females, average age 64.6 y, range 27-92 y. According to the Neer’s classification system, there were 10 two-part, 30 three-part and 7 four-part fractures. Twenty four patients were treated with minimally invasive percutaneous osteosynthesis internal fixation while 23 patients were managed with minimally invasive percutaneous osteosynthesis plus auxiliary tension suture fixation. Standard X-ray and physical examination post operation was performed. Consistant-visual analogue scale pain score, Constant-Murley score, University of California at Los Angeles score and disabilities of the arm, shoulder and hand score were comparable between the 2 groups. There were no significant differences between the 2 groups, however, a significantly greater supraspinatus force was observed in minimally invasive percutaneous osteosynthesis plus auxiliary tension suture fixation group compared to the minimally invasive percutaneous osteosynthesis alone group. Minimally invasive percutaneous osteosynthesis group had 2 cases of migration of great tuberosity and 1 case of acromial impingement. The auxiliary tension suture fixation group had 1 case of might valgus deformity and 1 case of fixation loosening and the complication rate was 12.5 % of minimally invasive percutaneous osteosynthesis group compared to the 8.6 % of auxiliary tension suture fixation group. Treatment of proximal humeral fractures with an auxiliary tension suture fixation was a good alternative to minimally invasive percutaneous osteosynthesis or conservative treatment, and should be performed routinely in displaced 2, 3 and 4-part fracturess.