Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation.
Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury). Following treatment by open reduction and internal fixation, only two of 23 patients with type-I injuries developed radiological evidence of osteonecrosis of the humeral head, compared with four of seven patients with type-II injuries. A policy of primary treatment by open reduction and internal fixation of type-I injuries is justified, whereas most elderly patients (aged 60 years or over) with type-II injuries are best treated by hemiarthroplasty. The best treatment for younger patients (aged under 60 years) who sustain type-II injuries is controversial and an individualised approach to their management is advocated.
The Shoulder Injury Clinic, The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, UK. c.mike.robinson@ed.ac.uk
C M
CM
Robinson
L A K
LA
Khan
M A
MA
Akhtar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000209:etiology; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006811:Humerus / Q000000981:diagnostic imaging / Q000601:surgery; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging; D018709:Statistics, Nonparametric; D016896:Treatment Outcome