OBJECTIVE: To explore clinical effect of allogeneic peroneal bone marrow support combined with plate internal fixation in treating Neer type Ⅳproximal humeral fractures.
METHODS: From December 2017 to December 2020,12 patients with Neer type Ⅳ proximal humeral fractures were treated with allogeneic peroneal bone marrow support combined with plate internal fixation,including 7 males and 5 females,aged from 56 to 78 years old;the time from injury to operation ranged from 1 to7 days. Operative time,fracture healing time and complications during follow-up were observed,and clinical efficacy was evaluated by Constant-Murley score at the latest follow-up.
RESULTS: All patients were obtained follow up for 20 to 29 months. All patients got bone healing and incisicons were healed at stageⅠ,operative time ranged from 95 to 138 min,blood loss ranged from 210 to 275 ml,fracture healing time ranged from 14 to 18 weeks. Two patients occurred postoperative shoulder stiffness and recovered after 2 weeks of passive exercise. There were no complications such as infection,poor wound healing,and failure (fracture and loosening) of internal fixators occurred. Constant-Murley shoulder function score ranged from 69 to 89 at the latest follow up,2 patients got excellent results,9 good and 1 fair.
CONCLUSIONS: The application of allogeneic fibular bone marrow placement could provide effective support for medial humerus,which is conducive to assisting reduction of fracture end,reducing occurrence of internal fixation failure caused by collapse of humerus head and screw perforation,and significantly improving function of shoulder joint.

BACKGROUND: A common type of Humerus fractures is about proximal. This study aimed to compare the results of surgical and non-surgical methods in treatment the Fracture of Proximal Humerus for decisions based on high-performance and less side effect.
METHODS: This prospective clinical trial study was done on 114 patients 30-80 years old with proximal humerus fracture referred to the Isfahan hospital universities (Ayatollah Kashani and Al Zahra hospitals) in 2007-2012. They were divided into two groups of 57 and treated surgically or non-surgically. The self provided questionnaires were used to assess the consequences of the side effects. The patients returned for trial check up during 6 weeks, 3 months, 6 months and one year after intervention.
RESULTS: In two parts fracture with displacement, nonsurgical treatment had lead to more complications rather than surgical treatment. In three-parts fracture non-union was seen in nonsurgical method in 6 weeks and in surgical method in 3, 6 months and one year after treatment, malunion was seen more in nonsurgical method rather than surgical method. In four-part fracture none-union results was seen more in nonsurgical method in 6 weeks, 3 months and one year and in surgical method in 6 months after treatment, mal union was seen more in nonsurgical method rather than surgical method.
CONCLUSIONS: The surgery in three and four parts fractures had fewer complications in the patients under 50 but not in the elders.