Abstract
Introduction: Three and four part fractures and fracture dislocations of the proximal humerus (Neer classification) presents a technical challenge for the shoulder surgeon. The high rate of excellent and good results of shoulder hemiarthroplasty reported by Charles Neer in the past was never again achieved by other surgeons in Israel and aboard. Up to day no satiafactory method of surgical treatment was for this group of fractures.
Purpose: The intention of this study is to demonstrate that the nonsurgical conservative management of complex proximal humeral fractures gives as good results as the surgical methods if not better.
Clinical Material and Methods: Between January 1, 2003 and December 31, 2003 fifty patients with three and four part fractures and fracture dislocations of the proximal humerus was treated in our outpatient facility. 25 patients were randomly selected for nonsurgical and 25 patients for surgical treatment. Three distinct groups were separated. The first group, selected for nonsurgical management, consisted of 19 female and 6 male patients with an average age of 66 years. The second group consisted of 9 females and 3 male patients treated by closed reduction and external fixation (CREF) or by open reduction and external fixation (OREF) with an average age of 67 years. The third group consisted of 10 females and 3 males treated by shoulder hemiarthroplasty with an average age of 70 years. Constant functional assessment score with “the limited goals” correction was used to evaluate the results.
Results: No significant differences were seen among the first and second group. Slightly better results were observed at the patients treated by external fixation means, but not statistically significant. The results of the hemiartroplasty group were found worse than the two previous groups, with statistically significant differences. It is interesting to mention that in the last group a better external rotation was seen in association with significantly worse abduction and forward elevation than in the first two groups.
Conclusion: Three and four part fractures and fracture dislocations of the proximal humerus are better managed by preserving the original head of the bone, even with gross deformity, than treated by hemiarthroplasty. Conducted by the results of this study we recommend to manage complex fractures of the proximal humerus by conservative methods or as needed by minimal invasive techniques (CREF or OREF).
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
