title: Treatment of 2- and 3-part fractures of the proximal humerus using external fixation: a retrospective evaluation of 62 patients.
abstract: BACKGROUND
  Treatment of fractures of the humeral head remains controversial. We reviewed the outcome of our treatment of 2- and 3-part fractures of the proximal humerus using external fixation as a way of preventing damage to the vascularity of the humeral head and of reducing the risk of infection associated with open techniques.
  
  
  METHODS
  We retrospectively evaluated 2- and 3-part fractures of the humeral head, both clinically and radiographically, in 62 consecutive patients who were treated using external fixation. The mean follow-up time was 1.5 (1-2) years.
  
  
  RESULTS
  The reduction was considered to be good in 50 cases, and 8 cases were consolidated in varus and 4 cases in valgus. The fracture healed in all patients. Except for 1 case of superficial infection around the screws and 1 redisplacement after a new fall, there were no early complications. Necrosis of the humeral head was not observed. 2 of the patients underwent shoulder replacement because of severe pain. The mean Constant score was 84 points, with satisfactory results (>or=80 points) in 49 of the 62 patients. Sex, age, side, or type of fracture had no influence on the outcome.
  
  
  CONCLUSIONS
  This procedure provides satisfactory early functional results, simplifies rehabilitation by limiting postoperative motion to a lesser degree than other techniques, is less aggressive than open reduction techniques and osteosynthesis, and leads to few complications.
authors.affiliation: Department of Orthopaedic Surgery, Obispo Polanco Hospital, Teruel, Spain. cmartin@cmedico.e.telefonica.net
authors.forename: Carlos
authors.initials: C
authors.lastname: Martin
authors.forename: Melchor
authors.initials: M
authors.lastname: Guillen
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Lopez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome