Minimally Invasive Surgical Method for Fractures of the Proximal Humerus

Purpose of work was improving treatment outcomes by developing an extramedullary minimally invasive method in fractures of the proximal portion of the humerus.

Materials of the scientific work is devoted to clinical dada of 55 patients with multiple fragment fractures of the proximal portion of the humerus. The Neer (1970) classification was used to assess the severity of the injury and the condition of the bone fragments. Most patients fall into the category of surgical fracture of the humerus, of these, 8 (14.6%) were single-fragment fractures, 14 (25.3%) were double-fragmented, 15 (27.3%) were three-fragmented, and the remaining 18 (32.8%) were multi-fragmented fractures. All patients made surgery using new operative technique using an extramedullary minimally invasive method with Ilizarov apparatus and atraumatic threads in different directions through the rotator cuff muscles of the shoulder attached to the bone fragments for the ideal repositioning of the bone fragments.

Results. Out of a total of 55 patients, 47 (85.4%) had a total score above 90 and were rated as good outcomes. Satisfactory results were obtained in 5 (9.2%) patients with the total score about 80 - 89. The satisfactory results were explained by the limitation of the amplitude of movement up to 10 degrees in the shoulder joint. In the remaining 3 (5.4%) patients, an unsatisfactory result was observed, the total score was less than 80, i.e., the presence of pain syndrome in the shoulder joint in these cases, limitation of range of motion to 15 degrees, and was explained by the presence of signs of osteoarthritis in the control X-ray image. After the surgery, all patients underwent shoulder rotator cuff restorative treatments for the prevention of "impingement syndrome", on the 21-25th day after the surgery, therapeutic physical exercises for the shoulder joint were started.

Conclusions.

Discussions on the choice of treatment for fractures of the proximal part of the humerus are growing. The proposed method of minimally invasive osteosynthesis in fractures of the proximal part of the humerus allows for less traumatic reposition of bone fragments, stable fixation of bone fragments. The proposed method of minimally invasive osteosynthesis allowed to increase the share of good and satisfactory results to 94.5%, as well as to improve the quality of life of patients.