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Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 154 - 154
1 Feb 2004
Dimakopoulos P Panagopoulos A Chanos M Sygelos S Lambiris E
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Aim: The evaluation of outcome of 4-part valgus impacted fractures of the proximal humerus after reconstruction with stable transosseous suturing fixation

Methods: 52 patients (34 female, 18 male, mean age 49,5y) with displaced 4-part “valgus impacted” fractures of the proximal humerus, were operatively treated between 1993–2002. The average impaction angle was 42.4° and the lateral displacement of the humeral head between 1–7 mm. In situ, stable fixation of the tuberosities to each other, to the articular part of the humeral head and to the metaphysis at a level below the top of the head, was achieved with heavy non-absorbable sutures, avoiding reduction maneuvers and any use of hard material. Early passive motion with pendulum exercises was applied at the 2nd postoperative day, followed by active assisted exercises after the 6th postoperative week and final strengthening exercises after the 3rd postoperative month

Results: Long term results (mean follow up 5.6 years), were evaluated according to Constant-Murley Scoring System. 45 patients (86.5%) had very good result (Constant score > 80) without pain and satisfactory motion (up to 160° forward elevation, 60° to 80° external rotation and internal rotation up to T12). The incidence of avascular necrosis was 5.7 %. Complications developed in 6 patients: 1 malunion of the great tuberosity, 3 heterotopic ossifications and 2 nonunions revised to hemi-arthroplasty and plate osteosynthesis respectively

Conclusions: Advantages of this minimally invasive technique are shorter operative time, no use of hardware, less soft tissue damage, low incidence of avascular necrosis, stable fixation with tension band effect and adequate rotator cuff repair, allowing for early joint motion