title: Two-part and three-part fractures of the proximal humerus treated with suture fixation.
abstract: OBJECTIVE
  To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with nonabsorbable rotator cuff-incorporating sutures.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  There were 27 patients (28 shoulders) with displaced proximal humerus fractures. There were 13 greater tuberosity (GT) and 9 surgical neck (SN) two-part fractures and 6 GT/SN three-part fractures. The average age was 64 years (range 38 to 84 years). The average follow-up was 4.4 years (range 1.0 to 11.5 years).
  
  
  METHODS
  All patients were surgically treated solely with heavy polyester nonabsorbable sutures.
  
  
  METHODS
  Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score and Neer's criteria, which grade outcomes as excellent, satisfactory, or unsatisfactory.
  
  
  RESULTS
  Overall, there were 22 (78%) excellent, 3 (11%) satisfactory, and 3 (11%) unsatisfactory results, and the average ASES score was 87.1 (range 35.0 to 100.0). All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. Twenty-four shoulders (86%) had anatomic alignment on postoperative radiographs. Of four shoulders with nonanatomic alignment, three had ASES scores of >/=90, with excellent Neer scores. When comparing patients with isolated two-part GT fractures (n = 13) with patients having two-part SN or three-part SN/GT fractures (n = 15), there were no statistically significant differences with respect to range of motion (P > 0.05) and outcome measures (P > 0.05). All patients who had unsatisfactory outcomes were noncompliant with physical therapy, with ASES scores averaging 39.4 (range 35.0 to 43.3).
  
  
  CONCLUSIONS
  Two-part and three-part GT and SN fractures can be treated satisfactorily with heavy nonabsorbable rotator cuff-incorporating sutures, particularly in elderly patients. Hardware-associated complications are obviated. Patients with SN fractures treated with sutures can have outcomes similar to patients with two-part GT fractures. Although the goal is to reconstruct a "one-part" fracture pattern, some residual deformity does not preclude an excellent outcome. A compliant patient is crucial for a successful result.
authors.affiliation: Center for Shoulder, Elbow and Sports Medicine, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York, USA.
authors.forename: Maxwell C
authors.initials: MC
authors.lastname: Park
authors.forename: Anand M
authors.initials: AM
authors.lastname: Murthi
authors.forename: Neil S
authors.initials: NS
authors.lastname: Roth
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Blaine
authors.forename: William N
authors.initials: WN
authors.lastname: Levine
authors.forename: Louis U
authors.initials: LU
authors.lastname: Bigliani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D013537:Sutures