Abstract
A series of 116 patients surgically treated, with exclusion of arthroplasty, between December 1996 and December 2002 for a fracture of the proximal humerus, was retrospectively reviewed. Only 44 patients (45 shoulders) were available for clinical and radiological follow-up, 21 were deceased, 36 refused to participate and 14 could not be traced.
The mean age was 60 y (15–93 y), the mean follow up was 44 months (15–78 m.); 28 were women, 16 men.
The fractures were classified according the Neer-classification but also according the different types of surgery they underwent: percutaneous or retrograde pinning without opening the fracture site, osteosynthesis with plate and screws, osteosynthesis with screws alone, bone-graft and osteosutures or a combination of two or more methods.
Two-part fractures (10 out of 13 fractures), but also 9 of the 15 three-part fractures, were treated by pinning, whereas the remaining 2 and 3-part, the isolated fractures of tuberculi and two 4-part fractures needed open surgery and fixation. A plate was used in only 3 cases, screws alone in 6 cases, a cortical bone-graft with osteosutures in 4 cases and a combination of open fixation in 8 cases. Whenever possible a minimal invasive technique was thus preferred.
16 patients (35,7%) had complications: 6 were minor (pin migration, slight secondary displacement or impingement as a consequence of protruding hardware), but one non-union, 4 CRPS and 5 avascular necrosis occurred. Only one of the latter underwent shoulder-arthroplasty at time of review. Major complications occurred mainly in the more complex fracture types (3 or 4 part fractures)
Mean values of Constant score, ASES-score, Neerscore, UCLA score and Simple Shoulder test were not statistically different, neither between fracture types nor between surgical techniques. Using a correlation analyses we found a negative correlation between age and scoring systems: the older the patient, the lower the score. Patient satisfaction was higher in the percutaneous or retrograde pinning group than the other types of open surgery.
We can conclude that although no statistical differences could be observed in our series, minimal invasive surgical techniques, less prone to complications, are preferable in the treatment of two and three part fractures of the proximal humerus and 4-part fractures of the younger population.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
