Effects of combined external fixator and locking plate internal fixation on clinical efficacy and blood loss in elderly patients with high-risk proximal humeral fractures
HUI Hongchao
TIAN Yafeng
WANG Jiangyong
ZHOU Hai
LI Zesong
ZHANG Shubin
TIAN Ye
Abstract：Objective To analyze the clinical efficacy and blood loss of combined external fixator and locking plate internal fixation in the treatment of elderly patients with high-risk proximal humerus fractures.Methods Forty-five elderly patients with high-risk proximal humeral fractures who were admitted from January 2022 to December 2023 were selected.Based on the different surgical approaches,20 patients treated with combined external fixator were included in the external fixator group,and 25 patients treated with locking plate internal fixation were included in the locking plate group.The perioperative indicators and blood loss of the two groups were compared.The visual analogue scale(VAS)pain scores,Constant-Murley scores,and the range of motion(ROM)of shoulder flexion,abduction,and external rotation before surgery,and at 1,3,and 6 months after surgery were compared between the two groups.The occurrence of postoperative complications in the two groups was observed.Results The duration of operation,incision length and length of hospital stay in the external fixator group were all shorter than those in the locking plate group(P<0.05).There was no significant difference in the fracture healing time between the external fixator group and the locking plate group(P>0.05).The total blood loss,visible blood loss and hidden blood loss in the external fixator group were less than those in the locking plate group(P<0.05).Before surgery and at 1 and 6 months after surgery,there was no significant difference in VAS pain scores,Constant-Murley scores,shoulder flexion ROM,shoulder abduction ROM,and shoulder external rotation ROM between the two groups(P>0.05).At 3 months after surgery,there was no significant difference in VAS pain scores,Constant-Murley scores,shoulder flexion ROM,and shoulder external rotation ROM between the two groups(P>0.05),but the external fixator group had better abduction ROM than the locking plate group(P<0.05).At 1,3 and 6 months after surgery,the VAS pain scores of both groups showed a decreasing trend over time(P<0.05),while the Constant-Murley scores,shoulder flexion ROM,shoulder abduction ROM and shoulder external rotation ROM all showed an increasing trend over time(P<0.05).No complications such as incision infection,needle tract infection,deep vein thrombosis,loosening or breakage of internal or external fixators,or non-union of fractures occurred in either group after surgery.Conclusion Both internal fixation with locking plates and combined external fixators have excellent clinical efficacy for elderly patients with high-risk proximal humeral fractures.The combined external fixation technique is closed reduction,with less surgical trauma,simple operation,and less impact on the amount of blood loss for patients.It is more appropriate for elderly patients with high risks whose fractures have smaller displacements and poorer physical conditions.During clinical treatment,the appropriate surgical method should be selected based on the specific conditions of patients with proximal humeral fractures.
Keywords：proximal humeral fractureelderlyexternal fixatorlocking plateshidden blood lossConstant-Murley scorevisual analogue scalesshoulder range of motion
Publication Date：2026-03-13
Online Publishing Date：2026-03-20(First online date of this platform, not the publication date of the document)
Pages：10( 51-60 )