Proximal humerus fracture is more common in clinical practice. Its incidence accounts for 5% of total body fractures, especially in elderly patients over 60 years old. The incidence accounts for the third place in the incidence of all fractures in the body, second only to distal radius fracture and elderly hip fracture. Proximal humerus fractures are often combined with shoulder subluxation, dislocation, rotator cuff, and nerve injury, and the supraspinatus muscle is the most common injury in the rotator cuff. MRI identified the suspected rotator cuff injury. The rotator cuff is composed of the supraspinatus muscle, infraspinatus muscle, subscapularis muscle, and teres minor muscle wrapped around the head of the humerus, a set of tendon complex, to help complete the shoulder joint lift, rotation, rotation, and other movements. At the same time, the rotator cuff is also an essential structure for stabilizing the shoulder joint. Currently, there are many types of rotator cuffs, which can be divided into complete and partial cuffs, depending on the depth of the tear in the clinic. According to tear length, full-layer tears can be divided into mild tears (tear length of <1 cm) , moderate tears (tear length 1-3 cm) , severe tears (tear length of >3-5 cm) , and colossal tears (tear length of >5 cm) . For patients with shoulder joint trauma, the purpose of treatment of proximal humerus fracture is to restore the integrity of the shoulder joint, and the purpose of treatment of rotator cuff injury is to maintain the stability of the original shoulder joint. In order to obtain satisfactory shoulder joint function, anatomic reduction and firm internal fixation are required. Currently, treating proximal humerus fractures accompanied by rotator cuff injury is controversial. However, more and more clinicians have begun to investigate the integrity of rotator cuff tissue and repair it before and during surgery, but there are few clinical studies on proximal humerus fracture combined with rotator cuff injury in China.

To study the characteristics and function of simultaneous repair of rotator cuff tear combined with locking plate screw in the treatment of elderly proximal humerus fractures.

From July 2015 to June 2018, 69 elderly patients with proximal humerus fractures were treated with surgery. Group A: 26 patients with rotator cuff injury with MRI before operation and intraoperative exploration; Group B: patients with other proximal humerus fractures; Sutures were used in 18 cases and anchors combined with sutures in 8 cases. The fracture was fixed with the PHILOS plate. All patients were protected by the outreach branch for four weeks and received a standard rehabilitation program. The two groups' operative time, intraoperative blood loss, and postoperative complications were recorded. The shoulder joint function was evaluated using the VAS pain score, ASES score, and Constant score 12 weeks after surgery and the last follow-up. The above indexes were compared.

Sixty-nine patients were followed for 12 to 21 months, averaging 13 months. All fractures were healed. In group A, wound infection occurred in 1 case, fat liquefaction occurred in 1 case, screw protrusion occurred in 1 case, and acromial impingement occurred in 1 case; in group B, wound fat liquefaction occurred in 1 case, screw protrusion occurred in 2 cases, and acromial impingement occurred in 2 cases, and no other complications such as nerve injury, plate screw rupture, shoulder dislocation, and necrosis of humerus head occurred. The postoperative VAS score was lower in the rotator cuff injury group at 12 weeks after surgery (P < 0.001) , and the difference was statistically significant. There was no statistically significant difference between the two groups in operation time, blood loss, VAS scores 24 hours and 12 months after surgery, ASES scores, and Constant scores 12 weeks and 12 months after surgery.

For the diagnosis of elderly patients with proximal humerus fracture combined with rotator cuff injury, it is recommended to use a locking plate combined with suture to repair the rotator cuff and restore the anatomical relationship between bone and soft tissue of the proximal humerus, which provides a prerequisite and favorable guarantee for the functional rehabilitation of shoulder joint.