Dissertation
Dissertation > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery

Clinical Study on Conservative Treatment and Surgical Treatment for Proximal Humeral Fractures Which Are A2,A3,B1According to the AO Classification

Author YeJingHua
Tutor XiangBao
School Hubei University of Chinese Medicine
Course Chinese medicine
Keywords conservative treatment Surgical treatment Proximahumeral fractures
CLC R687.3
Type Master's thesis
Year 2012
Downloads 30
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Objective:To investigate and compare the clinical result and the increased application of the two treatments including conservative treatment and surgical treatment for proximal humeral fractures which are A2,A3,B1according to the AO classification of the fractures of proximal humeral.Methods:A retrospective study is conducted to analyse the patients with proximal humeral fractures in the orthopaedic department of the161hospital of PLA from August2010to August2011. According to the case of inclusion criteria,45cases were brought to this research (31female and14male,range from50to75years). Then they were divided into two groups according to the different method of treatments:group A was used conservative treatment,group B was used surgical treatment. First we compared the fracture reduction through the X-ray films. In the follow-up24weeks, all of the cases in the two groups would have been observed for the shoulder function recovery (Constant-Murley shoulder function score) and the callus growth situation in4weeks,8weeks,24weeks after the treatment. The SPSSstatisticsl7software is used for analysis. The age, the gender and the fracture type in two groups are no significant differences.Results:1. The fracture restorationIn group A, there were6cases having best result,11cases having good result,5cases having satisfied result according to the fracture restoration standards. In group B,there were16cases having best result,7cases having good result,0cases having satisfied result according to the fracture restoration standards. The comparison of two groups had significant difference (p<0.05).2. The Constant-Murley shoulder function score in4weeks,8weeks,24weeks after the treatment. In the4weeks after the treatment, the cases of group A got the score of61.45+4.85points, the cases of group B got the score of59.96±5.17points. The comparison of two groups had no significant difference (p>0.05).In the8weeks after the treatment, the cases of group A got the score of83.68±3.05points, the cases of group B got the score of80.61±6.13points. The comparison of two groups had significant difference (p<0.05).In the24weeks after the treatment, the cases of group A got the score of92.55±2.46points, the cases of group B got the score of90.00±4.76points. The comparison of two groups had significant difference (p<0.05).3. The Constant-Murley shoulder function score in both the shoulders in24weeks after the treatment.In24weeks after the treatment, in group A, the health side got the shoulder score of93.05±1.73points, the other side of got the shoulder score of92.55±2.46points, there was no significant difference (p>0.05).In24weeks after the treatment, in group B,the health side got the shoulder score of92.26±2.07points, the other side of got the shoulder score of90.00±4.76points,there was significant difference(p<0.05).4. Callus growth in4weeks,8weeks,24weeks after the treatment. In the4weeks after treatment, In group A, there were0cases gettingOlevel,2cases getting I level,14cases getting II level6cases getting III level,0cases getting IV level according to the criteria of callus growth. In group B,there were5cases gettingOlevel,12cases getting I level,6cases getting II level,0cases getting III,0cases getting IV level according to the criteria of callus growth. The comparison of two groups had significant difference (p<0.05).In the8weeks after treatment, In group A, there were0cases getting0level,0cases getting I level,2cases getting II level,12cases getting III level,8cases getting IVlevel according to the criteria of callus growth. In group B,there were0cases getting0level,3cases getting I level,12cases getting II level,8cases gettingIII level, Ocases getting IVlevel according to the criteria of callus growth. The comparison of two groups had significant difference (p<0.05).In the24weeks after treatment, In group A, there wereO cases getting0level,0cases getting I level,0cases getting II level,0cases gettingIII level,22cases gettingIVlevelaccording to the criteria of Callus growth. In group B, there were0cases getting 0level,0cases getting I level,0cases getting II level1cases getting III level,22cases getting IV level, according to the criteria of Callus growth. The comparison of two groups had no significant difference (p>0.05).Discussion:Through this research,we find that the Callus growth and the shoulder function recovery of the conservative treatment for proximal humeral fractures which are classified as the A2-B1fracture in the AO classification are significantly better than surgical treatment,although the fracture restoration is inferiorer.To this kind of proximal humeral fractures, the treatment We used combine the Chinese traditional treatment with vertical traction,switching the shoulder.It avoids the shoulder absolutely immobilization, provides with the opportunity of the most early joint activity. It effectively reduces the soft tissue adhesion and the shoulder function restore faster and better. In addition,this method is effective to protect the fracture of the local soft tissue hinge,and the blood to the head of the humerus from disruption, and there are no tissue adhesion out of surgical. For proximal humeral fractures which are classified as the A2-B1fracture in the AO classification, the conservative treatmenth has firm fixation, early functional exercise. The fractures heal fast. The shoulder function has restored well. The method is worth in clinical application.

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