Abstract
Background: Avascular necrosis is a well recognised complication of displaced proximal humeral fractures irrespective of conservative and operative treatment. The reported rate of AVN with open reduction and internal fixation varies from 22 to 40%. The aim of our study was to look at the functional outcome and the incidence of AVN with operative treatment using locking plate with a minimum 3 year follow up.
Materials and methods: We retrospectively reviewed a consecutive series of 50 patients with displaced proximal humerus fractures treated with ORIF from 2002 to 2004. All patients were operated by the two senior authors employing anterior deltopectoral approach, indirect reduction, secure suture repair of the tuberosities and fixation with locking plate. The minimum follow up was 3 years. There were 9 two-part, 19 three-part and 22 four-part fractures. Their average age was 63 years. All patients were assessed objectively with Constant score and subjectively with Oxford questionnaire by an independent observer. Fracture healing and complications were recorded.
Results: 47 patients were available for follow-up. All fractures united. The average Constant score was 84. Their mean Oxford score was 16. There was no infection or metal work failure. One patient fractured below the plate after a fall but went onto uneventful union. 4 of 47 patients (8.5%) developed avascular necrosis. Three were four-part fracture and one was two-part fracture. Three patients underwent hemiarthroplasty of shoulder with good functional recovery. One patient declined further operative intervention due to low level of symptoms.
Conclusion: Indirect reduction and secure fixation of the tuberosities onto the humeral head with a locking plate is a reliable technique of treating displaced proximal humeral fractures. Our experience of avascular necrosis in only 8.5% of these fractures is much lower than any reported series after open surgery.
Correspondence should be addressed to The Secretary, British Elbow and Shoulder Society, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE
