Analysis of the clinical effect of the concept of "shoulder preservation" in the treatment of proximal humeral fractures: a retrospective cohort study of 66 patients

Background: The three- and four-part fractures of the proximal humerus are often combined with rotator cuff injury, and shoulder joint replacement is often selected clinically. The concept of "shoulder preservation" can greatly restore the function of the shoulder joint through internal fixation of the proximal humerus fracture and rotator cuff suture. This study investigated the clinical effect of the concept of "shoulder preservation" in the treatment of three- and four-part fractures of the proximal humerus. Methods: We conducted a retrospective analysis of 66 patients with proximal humeral fractures (PHFs) who were treated at the Affiliated Hospital of Qinghai University between 2016 and 2019. The patients were divided into 3 groups according to the Neer fracture classification system, and the fracture healing time of the 3 groups was compared. A visual analog scale (VAS) was used to evaluate the pain, and the Neer score was used to evaluate shoulder joint function. Results: The operations were successfully completed and the 3 groups of patients were compared in pairs. All incisions healed by first intention after operation, and no early complications occurred. The average follow-up time was 18 months. All fractures had healed. The VAS score of the 3 groups of patients was 1.5 +/- 0.5 at 1 month after operation and 1.0 +/- 0.5 at the final follow-up, which was significantly improved compared with preoperative scores, although the difference was not statistically significant (P>0.05). The Neer scores of the first group of patients at 1, 3, and 9 months postsurgery were higher than those of the second and third groups, and the difference was statistically significant (P<0.05). There was no significant difference among the 3 groups in Neer score 12 months after the operation (P>0.05). Conclusions: Proximal humeral internal locking osteosynthesis system (PHILOS) fixation + rotator cuff suture is a reliable treatment method involving a simple operation, firm fixation, and good postoperative recovery. It can restore shoulder joint function to the greatest extent, but it also has some shortcomings, including slow recovery time.