Objective To compare the effectiveness between operative and non-operative treatment for 3- and 4-part proximal humeral fractures in elderly patients. Methods Between January 2009 and January 2011, 35 patients with 3- or 4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation (n=20, operative group) and with closed reduction and splint or cast fixation (n=15, non-operative group). There was no significant difference in gender, age, etiology, fracture type, and disease duration between 2 groups (P gt; 0.05). The postoperative rehabilitation protocol was performed in 2 groups. Results All patients of the operative group achieved healing of incision by first intention. All patients were followed up 16 months on average (range, 12-20 months). The X-ray films showed that the other fractures healed except 1 case (5.0%) nonunion in operative group. Varus malunion was found in 1 case (6.7%) of non-operative group and 2 cases (10.0%) of operative group. Humeral head necrosis was found in 1 case respectively in 2 groups (5.0% and 6.7%). There was no significant difference in complication incidence between 2 groups (P gt; 0.05). The Constant-Murley scores of non-operative group and operative group were 64.7 ± 9.9 and 66.8 ± 11.8 at last follow-up respectively, showing no significant difference (t=0.59, P=0.47). Conclusion Operative treatment has similar effectiveness to non-operative treatment for 3- and 4-part proximal humeral fractures. In elderly patients, non-operative treatment should be chosen.
Objective To observe the effectiveness of the superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau. Methods Between June 2010 and February 2012, 20 cases of posterolateral fracture of the tibial plateau were treated through superior fibular head approach, including 1 case of simple posterolateral fracture of the tibial plateau and 19 cases of posterolateral fracture of the tibial plateau with other fractures. There were 12 males and 8 females with an average age of 42.2 years (range, 28-58 years). All patients had closed fractures. Fracture was caused by traffic accident in 14 cases, by falling from height in 4 cases, and by twist injury in 2 cases. Associated injuries included lateral meniscus injury in 5 cases, medial meniscus injury in 2 cases, and anterior cruciate ligament injury in 1 case. The time from injury to admission ranged from 90 minutes to 32 hours (mean, 4.5 hours), and the time from admission to operation was 5-12 days (mean, 7.8 days). All cases underwent fracture reduction and fixation with Pilon plates through the superior fibular head approach, and associated fracture and meniscal injury were treated. Results All incisions healed by first intention, and no numbness or articular instability occurred. All patients were followed up 6-26 months (mean, 19.1 months). The average fracture healing time was 10.2 weeks (range, 8-12 weeks). During following-up, no related complication of fixation loosening or articular surface loss occurred. According to Rasmussen knee score criteria at last follow-up, the score was 18-30 (mean, 27.9); 16 cases were graded as excellent, 3 cases as good, and 1 case as fair, with an excellent and good rate of 95%. Conclusion The superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau is simple, safe, and effective, and can achieve a good surgical outcome.