Locked plate osteosynthesis of humeral head–splitting fractures in young adults

Head-split fractures of the proximal humerus

“…In contrast to traditional beliefs, head-split fractures alone are not synonymous with head ischemia or even AVN. Gavaskar et al believe that the risk factors for AVN include a complex fracture pattern, the presence of anterior dislocation, the associated soft tissue injury, and the choice of the surgical approach (deltopectoral approach, used in the study for all anterior frac- ture-dislocations, has been shown to be associated with a higher incidence of AVN; [7]). Similarly, Ogawa et al reported that the split-head fragment in a posterior fracture-dislocation remained in good contact with an intact inferomedial attachment in 90% of the cases, and henceforth that the risk of AVN is low with head-splitting fractures associated with a posterior dislocation [22].…”

“…Gavaskar et al report that ORIF using a locking plate achieves satisfactory results in simple head-splitting fractures [7]. Out of 15 patients under the age of 55 years, bony union was achieved in 13.…”

“…In complex fractures (10 patients), head osteonecrosis was seen in four patients, nonunion in two patients, and posttraumatic osteoarthritis in one patient. Functional outcome scores showed significantly better results in simple fractures [7]. Chesser et al describe good results with internal fixation (one or two cancellous screws) in simple head-splitting fractures in three of the eight patients who were young (19-41 years), and opted for hemiarthroplasty in patients older than 55 years [4].…”

“…They also reported one case of glenohumeral arthritis, one case of primary intra-articular screw placement, two cases of secondary articular screw penetration after AVN and secondary collapse, and one patient with symptomatic impingement. Nonetheless, they recommended osteosynthesis in young patients, focusing on anatomic head and tuberosity reduction as well as bony union in order to provide a good bone stock for potentially necessary arthroplasty in the future [7].…”

Post-traumatic osteonecrosis of the proximal humerus

“…This supports earlier work by Chesser et al who analysed this injury in eight patients who were treated with internal fixation and found no cases of osteonecrosis at a mean three year follow-up. It is worth noting that this study comprised only of isolated head splitting fractures and more recent work [12] has suggested that the combination of a head-splitting fracture with associated tuberosity fractures is what is important. Gavaskar and Tummala [12] performed a retrospective review of 15 patients with a headsplitting fracture treated with internal fixation, defining isolated injuries as simple, and those with associated tuberosity fractures as complex.…”