Posterior four-part fracture-dislocations of the proximal humerus: clinical and functional evaluation of osteosynthesis treatment

Abstract

ObjectiveTo evaluate patients diagnosed with posterior four-part fracture-dislocations of the proximal humerus, that were surgically treated with osteosynthesis, regarding their clinical and functional outcomes.MethodsA prospective observational study of eight patients from the same hospital institution in the interior of São Paulo State (Brazil), through individual interviews using the UCLA, DASH, and Constant international scores. The active movements included in the scores plus the range of motion of the affected and non-affected limb were measured. The affected shoulder's radiographs were requested to verify bone conditions and the fixation of the osteosynthesis.ResultsThe rating of eight patients by the international scores indicated that seven of the eight patients presented good clinical and functional evolution of the affected limb; this represents 87.5% of the evaluated individuals.ConclusionSurgical treatment with osteosynthesis performed during the acute period (<four weeks) leads to good results in most cases.

Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus

“…The results of this study mirror those in the literature of case series that show good to excellent results after open reduction surgery of SNFs [21][22][23]. Johnson and Pandey published a case series of 11 patients with three-and four-part SNFs and were able to show promising results (mean CS of 75 (range 64-86)) [22].…”

“…This difference was statistically not significant. This is in accordance with case reports and case series on this topic [3,21,24]. Trikha et al analyzed the functional outcome of posterior fracture dislocations treated with locking plates in a level-4 study that included 33 patients [3].…”

“…The most important finding of this study is that humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus yields a good clinical outcome. Secondly, patients with SNFs showed inferior outcomes compared to patients with ITFs [18,21,22].…”

Posterior fracture dislocation of the proximal humerus

“…A common complication following a posterior fracture dislocation of the humerus is a locked position of the joint surface on the posterior glenoid rim [10,11]. When presented in the emergency room, this situation often remains undiagnosed [12][13][14][15][16][17][18][19][20]. This adds to the already complex nature of the posterior dislocation fracture of the humerus, which requires an elaborate open reduction and internal fixation.…”

“…In previous studies, a high occurrence of complications, and therefore poor functional outcomes, was reported [23,24]. Surgical options include joint replacement as well as surgical treatments that aim to preserve the humeral head by open reduction and internal fixation, with the use of auto-or allografts [12,14,[25][26][27][28][29][30][31][32][33][34]. More recent publications have been primarily case reports, while larger case series often date back more than 10 years [31,32,34,35].…”