Internal fixation of complex fractures of the proximal humerus

Abstract

We treated 34 consecutive articular fractures of the proximal humerus in 33 patients with good bone quality by open reduction and internal fixation. Anatomical or nearly anatomical reduction was achieved in 30, at a mean follow-up of 63 months (25 to 131), complete or partial avascular necrosis had occurred in 12 cases (35%). Two patients subsequently underwent arthroplasty and six further patients required additional surgery. The 32 patients who did not require arthroplasty obtained a mean Constant score of 78 points or 89% of an age- and gender-matched normal score (66 points or 76% in the presence and 83 points or 96% in the absence of avascular necrosis (p < 0.0005)); 22 were painfree, and seven had mild pain and three moderate pain. The mean active anterior elevation was 156 degrees. Internal fixation of complex fractures of the proximal humerus restored good shoulder function if avascular necrosis did not develop.

Proximal Humerus Fractures; Radiological and Functional Outcome as Treated With the Philos Plating System, at a Tertiary Care Centre in Karachi, Pakistan.

“…We did not observe any incidences of avascular necrosis in our series, however the literature reports an incidence rate of 4% to 75%, this could be due to the smaller duration of follow up in our study, a longer follow up time may yield incidence of this complication. 17,21,24 The most important factors in humeral head ischemia post fracture according to Hertel et al, are the dorsomedial extension at the metaphysic (less than 8mm), medial hinge integrity (a displacement of more than 2mm of the shaft) and fracture with the 2,9,10,11 and 12 (binary description system) components of the anatomic neck of the humerus. The positive predictive value of the ischemia is 97%, upon the presence of all three of the afore mentioned criterion.…”

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

“…Fracture healing was based on the disappearance of visible fracture lines on all radiographic views. Hardware positioning and anatomic alignment were based on plate positioning relative to the humeral head, head-neck angle, and presence or absence of screw penetration on all radiographic views [2,10]. To determine changes in hardware positioning and fracture collapse, we measured and compared ''humeral head height'' as described by Gardner et al [9] in sequential radiographs.…”

“…In the remaining 20%, fracture fragments are displaced and may exhibit an unstable fracture pattern. In these cases where there is marked displacement and instability, nonoperative treatment can yield less than satisfactory results and operative fixation is often indicated [3,10].…”

“…A wide variety of fixation devices have been developed over the past several decades to treat displaced and unstable proximal humerus fractures [3,10]. In our review of the literature, however, we found there is little agreement on the choices of treatment of these complex Each author certifies that he/she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

“…The widely accepted treatment of severely comminuted intra-articular proximal humeral fractures is hemi-arthroplasty or total shoulder arthroplasty [6,7]. Several surgical treatment options, such as closed reduction and percutaneous fixation [8], open reduction and internal fixation with a variety of constructs [9][10][11][12][13], proximal humeral intra medullary nailing [14] and shoulder arthroplasty [15], have been used with relatively good outcomes.…”