Comparative Study between External Fixation and Locked Plate for Management of Displaced Two Part Fractures of the Surgical Neck Fractures in Elderly

Background: The aim of our study is to assess the results of closed reduction and external fixation (EX-FIX) for displaced surgical neck humeral fractures in elderly patients compared with open reduction and internal fixation with locked plate.Patients and Methods: A total of 40 patients with displaced surgical neck fractures were seen from April 2015 to February 2017, 19(47.5%) males and 21(52.5%) females, of mean age 66.37 years They were randomized by sealed envelope into either open reduction and internal fixation or EX-FIX group. The radiological union was judged by callus formation, progressive obliteration of the fracture line, and maintenance of the reduction. The patients were evaluated clinically using the Constant Shoulder Score.Results: The mean Constant score in the EX-FIX group was 63.8, and in the plate group 67.55 with no significant differences in shoulder function between the groups regarding pain, range of motion, power or activities of daily living. The median and IQR of radiological union in the EX-FIX group was 8.5 weeks (7–10), while in the plate group, it was 8 weeks (7–8.5) with no significant difference between both groups. The rate of intra-operative complication in the EX-FIX group was 20 versus 10% in plate group and the rate of postoperative complication in the EX-FIX group was 40 versus 15% in the plate group with no significant difference between both groups. There was a significant decrease in the EX-FIX group regarding the operative time, blood loss, and hospital stay.Conclusions: Elderly patients with osteoporosis and comorbidities may benefit by this type of mini-invasive surgery with low soft tissue damages. Especially, the eventual loss of reduction did not affect functional recovery.