RESULTS OF THE TREATMENT OF COMPLICATED FRACTURES OF THE PROXIMAL HUMERUS

Abstract

Purpose: The aim of the study is to analyse the results taking into consideration the type of fracture, patients’ age and the method of the applied osteosynthesis

Material/Method: 468 cases of proximal humerus fractures were treated during the time period from 2000 to 2004.136 (29%) of the treated cases were mens and 332(71%)womens. The range pf patients’ age was from 14 to 91. The average age was 52.2 years. 97(20.7 %) cases were between the ages of 14 and 50. 371(79.3 %) cases were between the ages of 51 and 91. The fractures were categorized according to AO classification.

• A type – 267(57%) cases;

• B type – 143(30.6 %) cases;

tC type – 58(12.4 %). > 277(59 %) cases from the total of 468 were treated surgically:

• A type – 151(56.6% from the total of 267 A type cases);

• B type – 82(57.3 % from the total of 143 B type cases);

• C type – 44(75.9 % from the total of 58 C type cases).

The study included surgically treated B and C type cases, total of 126. From these we received 76 responses, either by examining the patients in person or by receiving questioneries filled out by the patients. The surgical treatment was performed using the following techniques:

• OS with plate (T, L, others) – 71(56,34%);

• OS with plate+tension band, bone sutures – 23(18,25%);

• OS with K – wires, K – wires + tension band – 13(10,32%);

• OS with screws; screws + tension band-13(10,32%);

• Hemiarthroplasty-6(4,76%).

• The follow up results were evaluated by using the UCLA END – RESULT SCORE

Results: Overall: 14(18.4%) excellent; 34(44.7 %) good; 8(10.5 %) satisfactory; 20(26.3 %) poor.

Poor results:

1. Type of fracture:

   • II. B1-4; B2-6; B3-6.

   • III. C1-2; C3-2.

2. Method of surgically treatment:

   • OS with plate (T, L, others) – 8(11,26%);

   • OS with plate+tension band, bone sutures – 4(17,39%);

   • OS with K-wires, K-wires + tension band – 6(46,15%);

   • OS with screws; screws + tension band – 2(15,38%);

   • Hemiarthroplasty – 0(0%).

3. Patients‘ Age:

   • 70–75 years – 6 patients. This constitutes 24% from the total number of 25 operated patients in this age group.

   • 76 – 80 years – 10 patients; over 80 years – 4 patients. This constitutes 64% from the total number of 22 operated patients in this age group.

Conclusions: In 73% cases functional results proved to be excellent and good, or satisfactory (excellent and good in 63.15 % of cases). K-wires and K-wires + tension band treatment most often (in 46,15% of cases) showed poor results and therefore is not a recommendable treatment. Hemiarthroplasty should be used more frequently in C type fractures treatment. In 85 % cases the results proved to be good. The necessity of surgical treatment and the most appropriate method should be seriously evaluated when treating patients over the age of 76 years with B and C type fractures.