HOFFMAN EXTERNAL FIXATORS IN THE TREATMENT OF PROXIMAL FRACTURES OF THE HUMERUS

Abstract

Introduction and Objectives: This study was designed to analyze the results of treatment of proximal humeral fractures using the Hoffman external fixator, evaluated using the Neer classification and Constant scale.

Materials and Methods: From January 1987 to June 1996, a total of 53 patients with proximal fractures of the humerus were treated using external fixation. Two of these cases had multiple injuries and died in the intensive care unit (ICU). For this reason, follow-up was done of the remaining 51 cases. There were 34 males (67%) and 17 females (33%). Average age was 52 years (range: 26–80). It is important to note that, of this group, 21 patients had multiple injuries in addition to the fracture of the humerus. There were 7 with craneoencephalic trauma, 11 with thoracic trauma, 3 with abdominal trauma, and 12 with fractures of other extremities. Eleven (20.7%) of the patients required admission to the ICU. Most frequent aetiologies were automobile accident in 31 cases (61%), accidental fall in 15 cases (29%), and other causes in 5 cases (10%). No significant difference was found based on the side that was affected. Fracture types in this study were as follows: Type III displaced fracture, 2 parts: 23 cases (45%); type IV displaced fractures, 3 and 4 parts: 15 cases (27%); type V displaced fractures of 3 and 4 parts: 10 cases (20%); type VI fractures of 3 and 4 parts with anterior luxation, 3 cases (8%) (Table 1). Three fractures were open Grade II or Grade III fractures (Couchoix), and 2 with associated comminuted fractures of the ipsilateral humerus.

Results: Clinical development was assessed in the 51 cases at an average of 20 months after removal of the external fixator (maximum 6 years).

* Pain: Average score 11.3 *Daily-life activities: Average score 14.7 points out of a maximum 20 points; 80% of patients achieved activity similar to pre-fracture levels. * Mobility: Average score was 24.6 out of 40. * Strength: Average score was 17 points. Overall average score for all patients out of 100 points on Constant’s scale was 67.7. Complications included local infection of the wound at the screw site in 4 cases, all of which were proximal screws. Algodystrophy was present in 3 patients. Three patients presented subacromial conflict after consolidation. No surgical iatrogenic injuries to vascular or nervous tissues were noted. Subjective results: Patients showed good acceptance of the external fixator due to the fact that it caused them little incapacity during treatment.

Discussion and Conclusions: External fixation is a quick and simple method which avoids entering the arm and affords similar results. As a minimally-invasive treatment technique, in case of failure, any other method may be used, including replacement arthroplasty, since passive movement of the shoulder is maintained from the beginning.