For the treatment of proximal humeral fractures two major therapeutic principles can be employed: Intramedullary nailing (PHN) or locking plate osteosynthesis. Aim of this study was to evaluate and compare clinical and radiological long-term outcome of proximal humeral fracture stabilization using PHN or angular stable plating. In addition, we discussed advantages and disadvantages of both techniques and aimed at establishing criteria which operative technique should preferentially be utilized for selected fracture configurations. In a prospective study between 2003 and 2010 we analyzed 72 patients with proximal humeral fracture who had been treated by PHN (44 patients) or angular stable plating (28 patients) in a European Level 1 Trauma Center. In the two cohort groups the following epidemiologic data was found. 46 patients were women, and 26 men with a mean age of 60.6 years (range 18–91). Follow-up was performed 38–82 months after accident, on average. Mechanism of injury was fall in 59, motor cycle accident in 4, bike accident in 8 patients, and fall from horse in 1 patient. Duration time between accident and operation was 2.8 days on average. Osteoporosis was previously known in 20 out of all evaluated patients (plate: 7/28; nail: 13/44). Fractures were classified using the Neer classification and Binary description system: There were 35 3-part fractures (PHN: 26; plate: 9) and 37 4-part fractures (PHN: 18; plate: 19), respectively. Functional and radiological outcome was assessed in a range of 38–82 months after trauma using Constant Score.Background
Materials and Methods
In Germany 427.500 persons per year were injured in traffic accidents. Because of faster cars the number of seriously injured persons increased. In a retrospective study we analysed the outcome and the posttraumatic quality of life (POLO Chart) of patients suffering from a severe trauma (ISS ≥ 50). Highlight of interest were:
pattern of injury injured part of the body days in ICU/days of external ventilation outcome actual state of health mental health changes in the social environment Between 1/2000 and 12/2005 1435 patients with multiple trauma were hospitalized in our Trauma Center, 88 (6,5%) suffered from a severe trauma with ISS ≥ 50. A total of 29 patients answered the POLO Chart. The most important pattern of injury were caused by traffic accidents (62%), Thoracic injury was the most common injury (94%) with an average AIS of 4,1. The patients with an ISS ≥ 50 spent significant more days in ICU and had significant more days of external ventilation than polytraumatized patients with an ISS <
50. 23% of the patients had a good outcome, 15% were severe physically handicapped and 36% died. Actually, more than half of the patients were more or less physically handicapped. 62% suffered from pain. 41% showed characteristics typically for a posttraumatic stress disorder. Only 15% were able to go back to work - on average two years after trauma. In conclusion the patients with severe trauma had a good survival rate, but they showed a poor posttraumatic quality of life, predominantly because of pain and mental ill like posttraumatic stress disorder. So in the time after trauma it is important to treat the whole patient and not only the physical lesions.
