We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p = 0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.
The postoperative and Radiologic control of 15 patients(20 foots) was continued for 1,5–7,5 y(M.3,5y).We had phone contact with 2 patients and for 1 patient, who died, we used the latest evaluation. All the patients were satisfied with the postoperative results. Walking and shoe use were incompliant. At 2 patients we mentioned slight hyperextension of the 1st MP joint and at 2 patients asymptomatic pseuthasrthrosis of the 1st MP joint. The M.V. of the HV angle was 17° and the inclination angle between Metatarsals and toes was 20°.The Phalanges showed mild to major degree Osteoporosis. The Hallux AOFAS Score was 83 (49–90) and for the remain toes 89,5(79–97).The results according to Mielke Score were very good at 15 foots and good at 5 foots.
