Comparative characteristics of treatment results mnogomillionnoi fractures of the humerus, by various methods of osteosynthesis

Kadyshev Vitaliy Valer'yevich, Solod Eduard Ivanovich, Lazarev Anatoliy Fedorovich, Zagorodnyi Nikolay Vasil'yevich

Aim: to evaluate the effectiveness of treatment of patients with fractures of the proximal humerus with the use of intense blocked spoke osteosynthesis in a comparative aspect with other modern methods of osteosynthesis. Materials and methods: 98 case histories of patients with the diagnosis "closed fracture of humerus at the level of surgical neck with displacement of fragments" aged from 27 to 89 years (22 men and 76 women, mean age 58.6±12.8 years) were analyzed prospectively. Group I (main) consisted of 36 patients who underwent surgical treatment by the method of"intense blocked spoke osteosynthesis". Group II was composed of 31 patients with intramedullary osteosynthesis pin. Group III consisted of 31 patients with fixation of fragments by the plate. Clinical data, laboratory and instrumental data were evaluated. Assessment of the functional status of the affected joint before the surgery was carried out a scale of the Mattis-Luborzyca-Schwarzberg before surgery and on 1, 15, 30, 90 and 180 days after surgery. The assessment of quality of life was performed using the SF-36 questionnaire. Results. It was found that the treatment of fractures of the proximal humerus by the method of strained blocked spoke osteosynthesis significantly increases the effectiveness of treatment of victims compared with intramedullary osteosynthesis pins and bone osteosynthesis plates. Reduced need and reduced the time of immobilization to 7-14 days. By day 14, the majority of patients in group I recovered the volume of joint movements in most patients, in groups II and III such patients were 68.7 (p=0.0001) and 77.7% (p=0.00001), respectively less. The terms of pain relief were reduced. The function of the damaged limb was restored by 15 days in 80.6% of patients of group I, whereas in group II – only in 22.6 (p=0.000001), and in group III – in 16.1% of patients (p=0.000001). Therapeutic exercise was conducted from 1 day in most patients of group I, in groups II and III, the coverage of rehabilitation measures in the first day was 85 (p=0.000001) and 90.3% (p=0.000001) less. Indicator of the effectiveness of surgical treatment against the development of complications was in group I - 94.4 per cent, in group II – 87,1%, in group III – 80,6%. Summary. The method of spoke blocked a busy osteosynthesis and more effective in the treatment of patients with fractures of the proximal humerus compared with intramedullary osteosynthesis with pins and a plate osteosynthesis plates. It is low-traumatic, has high efficiency and low frequency of complications, provides reliable fixation of fragments including in elderly patients, and full restoration of the function of the damaged limb in the early period after surgery.

Keywords:fracture of proximal humerus, osteosynthesis