Functional evaluation of management modalities of three and four part proximal humeral fractures

Abstract

Introduction: Three and four -part fractures represent 13%-16% of proximal humeral fractures. They occur more frequently in older patients after the cancellous bone has become weakened by senility and osteopenia. Treatment options for these displaced fractures include closed reduction and k-wire fixation, open reduction and internal fixation and arthroplasty. The purpose of the present study was to evaluate the functional results in patient with three and four-part proximal humeral fractures treated by different modalities, over a period of 2 years. Materials and Methods:We present a retrospective study of 40 three-part and four part proximal humeral fractures according to Neer's classification, treated by simple technique of Kirschner wire Osteosynthesis, open reduction and internal fixation with clover-leaf plate or proximal humeral locking plate system (PHILOS) and hemiarthroplasty of the proximal humerus. The criteria for inclusion were a diagnosis of undisplaced three-part fracture, displaced three and four part fractures confirmed by three independent observers. Results: The study was conducted over a period of two years with an average follow up of 20.7 months (Range: 12 to 40 months). There were 14 undisplaced three-part fractures impacted in valgus, seven displaced three part fractures, two three-part fracture with dislocated head, four four-part fractures with dislocated head. Conclusion: Three-and four-part proximal humeral fractures are difficult injuries to evaluate and treat. Nevertheless, an algorithm for treatment has been devised. Preoperative and intraoperative evaluation must address fracture pattern, bone quality, patient motivation, and expectations. A thorough knowledge of normal glenohumeral relationships is essential to achieve optimal surgical results.