Abstract
Introduction: The treatment of fractures of the proximal humerus is still controversial. Conservative treatment may result in severe disability due to malunion and shoulder stiffness. Open reduction and rigid fixation requires extensive soft tissue exposure, which may result in a high incidence of avascular necrosis of the proximal humerus. Today, many authors are in the opinion that “minimal osteosynthesis” of such fractures is preferable to rigid fixation. It may be achieved by K.W. techniques, lag screws, rush pins, percutaneous pinning or percutaneous external fixation. This study reviews our experience with comminuted fractures of the proximal humerus treated by different minimal invasive techniques of fixation, using functional evaluation and radiological assessment.
Materials and methods: This study consists of 76 patients with comminuted fractures of the proximal humerus (33 M, 44 F, 18–89 year old, mean 52/5Y) with follow-up of 2–6 years (mean 3.5Y). They were treated by minimal invasive surgical techniques: 53 of them by closed reduction and percutaneous pinning and the remaining 23 by ORIF and minimal osteosynthesis. All patients were evaluated by Neer’s shoulder grading score and radiographs.
Results: Overall results were excellent and good in 85% of patients with 2, and 3 parts fractures of the proximal humerus, treated either by closed or open minimal osteosynthesis techniques, with some better results in less comminuted fractures.
9/13 (69%) of young patients with 4 part fractures treated by closed percutaneous minimal fixation had good functional results. In four other patients the clinical results were poor and two of them developed AVN of the humeral head. 5/8 (62.5%) of young patients with 4 part fractures treated by ORIF and minimal fixation had good functional results. In three other patients the clinical results were poor and one of them developed AVN of the humeral head.
Conclusions: Based on this study it seems that “minimal osteosynthesis” by K.W. techniques and by lag screws, by closed or open reduction, remains as the first optional treatment of complex fractures of the shoulder, even in young patients with a 4 part fracture.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
