RESULTS OF THE TREATMENT OF COMPLICATED FRACTURES OF PROXIMAL HUMERUS

Abstract

We present the results of treatment of complicated comminutive fractures and fracture dislocations of the proximal humerus at the First Orthopedic Clinic of Prague in the last ten years. We also compare the results using two different methods of treatment: shoulder arthroplasty and non-anatomical shoulder reconstruction.

Treatment of complicated fractures of the proximal humerus is difficult. The results are not always good because the moving apparatus of the shoulder is often destroyed. The common method of treatment is shoulder arthroplasty with reconstruction of the rotator cuff. In our clinic we use (especially in young patients) the so-called non-anatomical reconstruction of the shoulder that enables us to save the humeral head. This reconstruction is suitable when three-fourths of the joint surface is preserved with the technical possibility of further fixation to the distal fragment.

From 1990 to 1999 we operated on 42 acute fractures not suitable for anatomical reconstruction or conservative treatment. Shoulder arthroplasty was performed in 22 patients and non-anatomical reconstruction in 20 patients. It was possible to maintain partial blood supply of the humeral head in seven patients. Evaluation of functional results was made by the method according to Constant and radiographs were also evaluated. In non-anatomical reconstruction we paid particular attention to the observation of the onset of necro-biotic rebuilding of the humeral head.

In the 22 patients who underwent shoulder arthroplasty, we recorded results of three excellent, fourteen good, four satisfactory and one unsatisfactory. In patients who had non-anatomical shoulder reconstruction, the results were four excellent, eleven good, four satisfactory and one unsatisfactory. Out of this group there were three excellent and four good results in patients with a partially saved blood supply to the humeral head. There are signs of necro-biotic changes of the humeral head in four patients, but its presence clearly has no direct effect on the final shoulder function.

There are significantly worse results from arthroplasty in trauma cases than in other diagnoses such as osteoarthritis and rheumatoid arthritis. According to our own method, non-anatomical reconstruction of the shoulder has comparable results. In addition, this procedure enables saving the humeral head. There is also the advantage of no problems that are associated with arthroplasty (infection, migration of components, etc.). We have achieved remarkably good results in non-anatomical reconstruction with partial saving of the blood supply of the humeral head. The development of necro-biotic rebuilding of the head has no direct influence on the functionality of the shoulder.