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Abstract Objective To investigate the clinical efficacy of surgical treatment of comminuted proximal humeral fractures.Methods Retrospective analysis of 58 cases of proximal humerus comminuted fractures treated with anatomical locking plate internal fixation between March 2010 and March 2016 in our hospital and complete follow-up was obtained.This study included 26 cases of male and 32 cases of female.The patients aged 60 to 85 years，with an average age of (68.5±2.5)years.According to Neer classification，there were 48 cases of 3-part fracture，10 cases of 4-part fracture，8 cases of proximal humerus comminuted fracture with shoulder dislocation，and 15 cases of craniocerebral injury combined with proximal humerus comminuted fracture.All of them were treated with proximal humerus anatomical locking plate for open reduction and internal fixation，postoperative external fixation，and guided early passive functional exercise.Clinical efficacy was evaluated by Neer shoulder function score，pain visual simulation score and Constant shoulder score.Reexamination of fracture healing by X-ray plain film.Results Follow-up time ranged from 24 to 60 months，with an average of (39±8.6)months.During the follow-up period，there were no case of humerus head necrosis.According to the Neer shoulder function score，there were excellent in 20 cases(34.5%)，good in 30 cases(51.7%)，medium in 6 cases(10.34%) and poor in 2 cases(3.45%).The 1 year follow-up after X-ray operation was up to the standard of clinical healing.Conclusion Early internal fixation for comminuted fractures of the proximal humerus and early operative internal fixation for fractures may be performed in patients with shoulder dislocation.Early functional exercise of shoulder joint was performed under the protection of postoperative abduction stent.It can not only obtain better shoulder joint function，but also be beneficial to the good healing of fracture，which can obtain more satisfactory clinical curative effect.
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