[Objective]To prospectively investigate the clinical efficacy of small incision(minimally invasive percutaneous plating os-teosynthesis,MIPPO)versus open reduction and internal fixation(ORIF)in the treatment of proximal humerus fractures in the elderly.[Methods]A total of 87 elderly patients with proximal humerus fracture admitted to our Department of Orthopedics from March 2019 to March 2022 were included into this study.The patients were divided into the MIPPO group(44 cases)and the routine ORIF group(43 cases)by random number table method.The documents regarding perioperative period,follow-up and images were compared between the two groups.[Results]All patients in both group had operation performed successfully.Although the MIPPO consumed significantly longer opera-tion time than the ORIF group[(94.3±9.2)min vs(79.1±10.8)min,P＜0.001],the former proved significantly superior to the ORIF group in terms of incision length[(7.4±0.9)cm vs(10.8±1.5)cm,P＜0.001],intraoperative blood loss[(138.6±8.9)ml vs(190.2±13.7)ml,P＜0.001],ac-tive movement time[(6.4±1.8)days vs(8.9±1.5)days,P＜0.001]and hospital stay[(8.5±0.7)days vs(9.7±1.1)days,P＜0.001].The VAS score,Constant-Murley score,forward flexion-uplift range of motion(ROM)and abduction-uplift ROM significantly improved over time in both groups(P＜0.05).At 3 months and the last follow-up,the MIPPO group was significantly better than the ORIF group regarding to VAS score[(1.3±0.5)vs(1.6±0.7),P=0.024;(0.8±0.4)vs(1.0±0.5),P=0.042].In addition,at 1 and 3 months after surgery,the MIPPO group was also superior to the ORIF group in Constant-Murley scores[(70.3±3.2)vs(68.3±3.9),P=0.011;(82.5±5.7)vs(80.1±4.5),P=0.032].At all cor-responding time points after operation,the MIPPO group proved significantly better than the ORIF in ROMs(P＜0.05).As for imaging,there was no significant difference in fracture reduction quality between the two groups(P＞0.05),while the fracture healing rate 8 weeks after sur-gery in the MIPPO group was better than the ORIF group[cases(％),34(77.3)vs 25(58.1)P=0.028].There was no significant difference in subacromial interval(SAI)between the two groups at any corresponding time points(P＞0.05).[Conclusion]Both MIPPO and traditional OR-IF can be used in the treatment of proximal humerus fractures in elderly.By comparison,the MIPPO can effectively protect the local blood circulation near the fracture ends,which is conducive to early healing and rehabilitation of fractures.
proximal humerus fracturesopen reduction and internal fixationminimally invasive percutaneous plating osteosynthesisproximal humerus internal locking system
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