116. TRANSOSSEOUS SUTURE OF 3-FRAGMENT PROXIMAL FRACTURES OF THE HUMERUS 4201

Abstract

Purpose of the study: Proximal fractures of the humerus account for 10% of fractures in persons aged over 65 years. There is no optimal treatment. The goal of surgery is to restore joint congruency, preserve vascular supply, and allow functional recovery. We describe the results obtained with a surgical technique designed to meet these goals.

Material and methods: Fifteen 3-fragment fractures of the proximal humerus were treated with transosseous suture. Mean age of patients was 58 years. Eighty-six percent of the patients were female. Follow-up was 18 months on average. The patients were placed in a lounge chair position for the deltopectoral or transdeltoid approach. For this type of fracture, the humeral head is displaced medially or laterally, so that care must be taken to ensure the realignment in the sagittal and coronal planes. The DASH and Constant scores were noted for the operated and non-operated shoulders. Signs of bone healing were noted on the plain x-rays.

Results: The mean DASH was 12, mean Constant score for the operated shoulder was 80 versus 90 for the other shoulder. The mean neck-shaft angle was 139°. There was one case of lost reduction but with a good final result. There was one case converted to arthroplasty.

Discussion: This technique is in line with the current trend for biological preservation minimising the aggression to the humeral head blood supply. There was no risk of migration with the fixation material used and no need to remove implants.

Conclusion: Transosseous suture of proximal fractures of the humerus is a mini-invasive method which provides good functional results avoiding voluminous metal implants, known to be costly and source of complications. The incidence of avascular necrosis of the humeral head is low, in agreement with the international literature.