title: Comparison between minimally invasive, percutaneous osteosynthesis and locking plate osteosynthesis in 3-and 4-part proximal humerus fractures.
abstract: BACKGROUND
  The ideal method for the surgical treatment of proximal humeral fractures has not yet been found. We therefore conducted a retrospective matched-pair analysis and compared osteosynthesis with open reduction and internal fixation and that with an angular stable plate with minimally invasive, closed reduction, percutaneous fixation with the Humerusblock.
  
  
  METHODS
  During a study period of 3 years, we matched 30 patients treated with angular stable plates (group 1) for age, gender, fracture type and handedness (dominant or nondominant) to 30 patients treated using the Humerusblock (group 2). At a minimal follow-up of 24 months, clinical evaluation included the Constant-Murley score, the UCLA score and the Simple Shoulder Test. Subjective pain was evaluated using the VAS pain scale. Patients were asked to rate their subjective satisfaction of final outcome as excellent, good, satisfied or dissatisfied.
  
  
  RESULTS
  The mean CMS, UCLA score and SST differed significantly between groups 1 and 2 (60.9 vs 71.9, p < 0.01), (25.1 vs 29.5, p < 0.01) and (8.1 vs 9.4, p < 0.05), respectively. The VAS pain score was significantly lower in group 2 than in group 1 (1.2 vs 2.4; p < 0.01). The mean abduction (109.7° vs 133.7°; p < 0.01) and anterior flexion (128.3° vs 145.7°; p < 0.01) were significantly worse in group 1. The mean operation time was significantly shorter in group 2 (117.3 vs 72.1, p < 0.01). Complications occurred in 30 % (group 1) and 23 % (group 2) of patients.
  
  
  CONCLUSIONS
  In this study, the functional outcome is superior in the Humerusblock group. However, the general outcome after surgical treatment of 3-and 4-part fractures is moderate, and the complication rate has to be considered, even though it can be lowered with the use of minimally invasive implants.
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria. r.ortmaier@gmail.com.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Ortmaier
authors.affiliation: Department of Traumatology, Diakonissenkrankenhaus Schladming, Salzburgerstraße 777, A-8970, Schladming, Austria. Verenafilzmaier@hotmail.com.
authors.forename: Verena
authors.initials: V
authors.lastname: Filzmaier
authors.affiliation: Department of Biostatistics, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria. wolfgang.hitzl@pmu.ac.at.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hitzl
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria. r.bogner@salk.at.
authors.forename: Robert
authors.initials: R
authors.lastname: Bogner
authors.affiliation: Landeskrankenhaus Horn and Paracelsus Medical University, Spitalgasse 10, A-3580 Horn, Salzburg, Austria. thneubauer@aon.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neubauer
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria. h.resch@salk.at.
authors.forename: Herbert
authors.initials: H
authors.lastname: Resch
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria. a.auffarth@salk.at.
authors.forename: Alexander
authors.initials: A
authors.lastname: Auffarth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011859:Radiography; D012189:Retrospective Studies