[Comparison of open versus percutaneous treatment for humeral head fracture].
BACKGROUND
The hypothesis of this study was that percutaneous techniques lower the risk of post-traumatic avascular necrosis.


METHODS
In this retrospective study 83 patients were followed up clinically and radiologically for signs of avascular necrosis and nonunion after open or percutaneous treatment of proximal humerus fractures. Mean age was 50 years. Fractures were classified in 22 patients (26.5%) as two part, in 21 patients (25.3%) as three part, in 39 patients (47%) as four part, and in 1 patient (1.2%) as fracture dislocation (Neer classification). Fractures were treated in 12 patients (14.5%) by ORIF (open reduction and internal fixation) and in 71 patients (85.5%) by CRPF (closed reduction and percutaneous fixation). Both groups were statistically equally distributed according to fracture type (Mann-Whitney U, p=0.267) and age (One-way-Annova, p=0.740). The postoperative regime did not differ between the two groups.


RESULTS
Patients suffered significantly more avascular necrosis after open treatment [five patients (50%) versus eight patients (12.7%) in the percutaneous group, Mann-Whitney, p=0.004]. The risk for avascular necrosis and nonunion increased with age. Mean age of patients with avascular necrosis was 57 years, and the age of patients with nonunion was 67 years.


CONCLUSIONS
Percutaneous treatment of humeral head fractures seems to be a reliable method for lowering the risk of avascular necrosis in young patients.
Kralinger
F
F
Klinik für Unfallchirurgie und Sporttraumatologie, Universität, Anichstrasse 35, A-6020, Innsbruck, Osterreich. f.kralinger@uibk.ac.at
Irenberger
A
A
Lechner
C
C
Wambacher
M
M
Golser
K
K
Sperner
G
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology / Q000517:prevention & control; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D011183:Postoperative Complications; D011542:Pseudarthrosis / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000150:complications / Q000601:surgery*; D012784:Shoulder Fractures / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome