Treatment of Displaced Fractures of the Proximal Humerus

Abstract

The treatment of fractures of the proximal humerus is challenging and good comparisons of results after treatment using conservative and operative means are lacking in the orthopaedic literature. The purpose of this study is to assess the 64-months outcomes of treatment of 66 displaced proximal humeral fractures by surgical procedures and conservative methods. Among the patients were 42 men and 24 women. The patient sample was divided in two groups. In the first group, 35 fractures were managed surgically. The methods ranged from percutaneous pinning to plate-fixation or primary hemiarthroplasty. In the second group, 31 patients were treated non-operatively. After reduction, the shoulders were immobilized with sling and swathe or Dessault’s dressing or orthosis. The clinical assessment was made using the Constant-Murley score. In the operatively treated group, the mean score for two-part fractures was 75.6 points, for three-part fractures 52.1 points, for four-part fractures 50.3 points and for fracture-dislocations 56.9 points. In radiographs, all fractures were healed and reduction was acceptable in all but one case. In 31 non-operatively treated patients, two non-unions were observed. The mean score for two-part fractures was 67.9 points, for three-part fractures 42.5 points and for four-part fractures 38.1 points. The mean difference between these two groups was 9.8 points - better results were achieved with use of operative methods.

Proximal humeral fractures - Treatment - Constant-Murley score

References

• 1 Brooks C H, Carvell J E. External fixation for fracture-dislocations of the proximal humerus.  J Bone Joint Surg [Br]. 1989;  71 864-865
• 2 Gobel F, Wuthe T, Reichel H. Ergebnisse der Humeruskopfprothese bei akuten und veralteten Frakturen des proximalen Humerus.  Zeitschrift Orthop Grenzgeb. 1999;  137 25-30
• 3 Hawkins R J, Bell R H, Gurr K. The three-part fracture of the proximal part of the humerus. Operative treatment.  J Bone Joint Surg [Am]. 1986;  68 1410-1414
• 4 Jaberg H, Warner J P, Jakob R P. Percutaneous stabilization of unstable fractures of the humerus.  J Bone Joint Surg [Am]. 1992;  74 508-515
• 5 Kocialkowski A, Wallace W A. Closed percutaneous k-wire stabilization for displaced fractures of the surgical neck of the humerus.  Injury. 1990;  21 209-212
• 6 Koval K J, Blair B, Takei R, Kummer F J, Zuckerman J D. Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques.  J Trauma. 1996;  40 778-783
• 7 Lill H, Josten C. Proximale und distale Humerusfrakturen im hohen Alter.  Orthopäde. 2000;  29 327-341
• 8 Lin J, Hou S M, Hang Y S. Locked nailing for displaced surgical neck fractures of the humerus.  J Trauma. 1998;  45 1051-1057
• 9 Loitz D, Konnecker H, Illgner A, Reilmann H. Retrograde Marknagelung von Humerusfrakturen mit neuen Implantaten.  Unfallchirurgie. 1998;  101 543-550
• 10 Neer C S. Articular replacement for the humeral head.  J Bone Joint Surg [Am]. 1955;  37 215-228
• 11 Roberts S M. Fractures of the upper end of the humerus. An end-result study which shows the advantage of early active motion.  JAMA. 1932;  98 367-373
• 12 Ruedi T. Treatment of displaced metaphyseal fractures with screw and wiring systems.  Orthopaedics. 1989;  12 55-59
• 13 Stoffel K, Fellmann J, Meier G, Bereiter H. Relevante Unterschiede nach posttraumatischem und degenerativem Humeruskopfersatz.  Zeitschrift Orthop Grenzgeb. 2000;  138 110-117
• 14 Stohr E, Holz U. Der metaphysare Trümmerbruch. Eine therapeutische Herausforderung.  Orthopäde. 2000;  29 342-352
• 15 Widen A. Fractures of the upper end of humerus with great displacement treated by marrow nailing.  Acta Chir Scand. 1949;  97 439-441