Objective To evaluate the cl inical significance of minimally invasive percutaneous plate osteosynthesis (MIPPO) appl ied in Neer II, III parts fractures of proximal humeraus. Methods The cl inical data were retrospectively analyzed, from 30 patients with Neer II, III parts fractures of proximal humeraus in accordance with selection criteria, who were treated with manual reduction and plaster external fixation (11 cases, non-operative group) or with MIPPO (19 cases, operative group) between January 2008 and May 2010. In non-operative group, there were 6 males and 5 females with an average age of 60 years (range, 56-80 years) and with an average time of 10 hours (range, 3-24 hours) between injury and reduction, including 8 cases of Neer II and 3 cases of Neer III. In operative group, there were 13 males and 6 females with anaverage age of 65 years (range, 45-78 years) and with an average time of 3 days (range, 1-5 days) between injury and operation, including 9 cases of Neer II and 10 cases of Neer III. There was no significant difference in gender, age, fracture type, and time from injury to operation (P gt; 0.05). The shoulder joint function before and after treatments was evaluated according to Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons’ Form (ASES) scoring systems. Results Thirty patients were followed up. In operative group, the follow-up time ranged from 11 to 18 months (mean, 12 months); all incisions healed by first intention with no compl ication of internal fixation failure, infection, or nerve injury. In non-operative group, the follow-up time ranged from 9 to 15 months (mean, 11 months). The X-ray films showed that fractures healed without humeral head necrosis in 2 groups. The bone heal ing time in operative group and non-operative group was (11.47 ± 2.48) weeks and (11.82 ± 2.44) weeks, respectively, showing no significant difference (t=0.369, P=0.889). The CMS score and ASES score at each time point after treatment were significantly better than those before treatment (P lt; 0.05); the CMS scores in operative group were better than those in non-operative group at 3 weeks, 3 months, and 1 year after treatment (P lt; 0.05); and the ASES score in operative group was better than that in non-operative group at 3 weeks and 3 months after treatment (P lt; 0.05), but no significant difference was found at 1 year after treatment (P gt; 0.05). Conclusion MIPPO fixation using the locking compression plate is an effective option for Neer II, III parts fractures of proximal humeraus. It can provide good functional recovery of the shoulder joint so that patients can get back to their normal l ife as soon as possible.
ObjectiveTo investigate the short-term effectiveness of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of anterior pelvic ring fractures. MethodsBetween January 2012 and October 2013, 16 patients with anterior pelvic ring fractures were treated with MIPPO. There were 10 males and 6 females at the age of 20-63 years (mean, 41 years). The causes of injury were traffic accident in 9 cases and falling from height in 7 cases. The duration of injury to admission was 2 hours to 5 days (mean, 1 day). According to Tile classification, 8 cases were rated as type B2, 4 cases as type B3, 2 cases as type C1, and 2 cases as type C2. Of them, 2 cases had iliac wing fracture, and 4 cases had pelvic posterior ring fracture. The time from admission to operation was 3-12 days (mean, 6 days). ResultsThe bleeding volume was 60-120 mL (mean, 70 mL). All wounds healed by first intention. No postoperative complication of deep venous thrombosis or long-term continuous pain occurred. All cases were followed up 5-27 months (mean, 11.5 months). No clinical manifestation of lateral femoral cutaneous nerve injury or spermatic cord injury was found, and cremasteric reflex existed in males. All cases obtained bony union, and the healing time was 12-16 weeks (mean, 13 weeks). During the follow-up period, no loss of fracture reduction and no internal fixation loosening or broken were observed. According to Matta radiological evaluation criterion, 16 cases had anatomical reduction, and 3 cases had satisfactory reduction; according to Majeed scoring system of pelvic fracture, the results were excellent in 12 cases and good in 4 cases. ConclusionMIPPO for treatment of anterior pelvic ring fractures has the advantages of less intraoperative blood loss, few soft tissue complications, and low infection rate, and can get satisfactory short-term effectiveness.