KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT KẾT HỢP XƯƠNG BẰNG NẸP KHÓA TRONG GÃY 3 - 4 MẢNH ĐẦU TRÊN XƯƠNG CÁNH TAY Ở BỆNH NHÂN TỪ 50 TUỔI TRỞ LÊN

Abstract

Introduction: Proximal humerus fractures involving 3-4 parts in the elderly present a significant challenge, with ongoing debate between choosing locked plating and shoulder arthroplasty. Although locked plating is widely utilized, postoperative complications remain high, particularly in patients with risk factors such as low bone density or multi-fragmentary fractures. The objective of this study is to evaluate the functional and radiographic outcomes of using locked plates for treating 3-4 part proximal humerus fractures in patients aged 50 and above, and to identify factors influencing outcomes and complication rates at the Department of Orthopedic Trauma, Ho Chi Minh City. Methods: This descriptive case series included 58 patients aged 50 and above, all of whom had 3-4 part proximal humerus fractures surgically treated with open reduction and internal fixation using locked plating. Results: The 58 patients had an average age of 62.78 years, with a follow-up period of 26.24 months. Of these, 41 cases involved 3-part fractures, and 17 cases involved 4-part fractures. The mean Constant-Murley score was 70.81, and the mean QDASH score was 8.33. Complications occurred in 10.34% of patients. Complex fractures (4-part fractures, medial hinge displacement > 2mm, larger calcar fragments) were associated with significantly poorer functional outcomes (p<0.05). Conclusion: Locked plating for 3-4 part proximal humerus fractures yields good bone healing and functional outcomes. Factors such as age, gender, bone density, bone grafting, and the use of rotator cuff sutures with high-strength sutures did not significantly impact postoperative functional outcomes. Thus, osteoporosis should not be considered a contraindication for locked plating in these fractures in elderly patients. However, more complex fractures involving multiple fragments, humeral head detachment, complete displacement, smaller calcar fragments (<2 mm), and displaced medial hinge fragments were associated with poorer functional outcomes and higher complication rates postoperatively.