We performed open reduction and internal fixation with a T-buttress plate in 32 fractures of the proximal humerus with severe displacement and/or fracture dislocation. In 27 cases acceptable reduction was achieved. In four cases infection developed, and the implant was removed in five cases because of impingement of the plate under the acromion and in two cases because of loosening. There was no nonunion, but four humeral head necroses. At the re examination of 20 patients after 2-7 years, nine were excellent or satisfactory and eleven unsatisfactory or poor. We conclude that the buttress plate offers satisfactory reduction and good stability at a high risk for complications. The indications for this method should be carefully considered, notably in the elderly, and the operation should only be performed by experienced orthopedic surgeons.

No abstract

The reliability of the Neer classification of proximal fractures of humerus was examined by determining the agreement between pairs of observers using weighted kappa statistics. Anteroposterior and lateral radiographs of 100 surgical neck fractures were grouped independently by four observers. A low degree of agreement was found, especially between the most inexperienced observer and the rest. Considering the therapeutic consequences of a correct classification, these fractures should be assessed by experienced orthopedic surgeons or radiologists.

A consecutive series of 31 displaced fractures of the proximal humerus were randomly selected for treatment either by closed manipulation or by transcutaneous reduction and external fixation. Follow-up assessed the quality of reduction and healing as well as the functional outcome. The external fixation method gave better reduction, safer healing and superior function.

A new technique for the treatment of displaced fractures of the proximal humerus is described. Twelve fractures in 11 patients were managed by transcutaneous reduction using a Steinmann pin, and external fixation with a Hoffmann-type neutralising bar connected to two half-pins in the humeral head and three half-pins in the shaft. The pins were removed after four weeks. Two patients sustained redisplacement after a further injury, but in the others reduction was maintained. Two cases of pin-track infection resolved after antibiotics, but delayed union resulted. There were no neurovascular injuries and at follow-up of 6 to 12 months no refractures had been seen. The early functional results were excellent or satisfactory in nine cases.