Long-term results after non-plate head-preserving fixation of proximal humeral fractures.
A retrospective study was conducted to evaluate displaced proximal humeral fractures treated with a non-plate head-preserving fixation and to detect factors predicting functional outcome. After a median follow-up period of 79.7 months, 105 patients with nine A-fractures, 36 B-fractures and 60 C-fractures (nine two-part-fractures, 41 three-part fractures and 55 four-part fractures) were assessed. Functional outcome was measured based on the Constant and UCLA scores. Of all patients, 70-75% had excellent or good Constant and UCLA scores. In 74% a good or satisfactory quality of initial reduction fracture was achieved. About one-fifth (21%) of the fractures showed a secondary displacement. Twenty-seven percent of the patients had signs of humeral head necrosis and 22% had implant related problems. There were significant correlations between a high final score and young age, low AO fracture severity, good quality of fracture reduction and residual osseous deformity, absence of secondary fracture displacement, implant-related complications, shoulder arthrosis and humeral head necrosis at the time of follow-up. In conclusion, the non-plate head-preserving fixation of proximal humeral fractures is an alternative treatment for displaced proximal humeral fractures. Especially in severely displaced C-fractures in older patients, non-anatomical reduction leads to a high rate of secondary displacement, residual osseous deformity and only a fair shoulder function. For these cases alternative methods such as prosthetic replacement should be chosen.
Bahrs
Christian
C
Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany. C.Bahrs@gmx.de
Badke
Andreas
A
Rolauffs
Bernd
B
Weise
Kuno
K
Zipplies
Sebastian
S
Dietz
Klaus
K
Eingartner
Christoph
C
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D055815:Young Adult
Orthopade. 1987 Aug;16(4):320-35
3658415
J Bone Joint Surg Am. 1992 Apr;74(4):508-15
1583045
J Bone Joint Surg Br. 1997 May;79(3):412-7
9180319
Int Orthop. 2006 Jun;30(3):153-7
16622671
J Bone Joint Surg Br. 2003 May;85(4):611-7
12793573
Chirurg. 2001 Nov;72(11):1235-45
11766645
Injury. 2001 Jun;32(5):363-72
11382420
J Trauma. 1996 May;40(5):778-83
8614080
J Shoulder Elbow Surg. 2007 May-Jun;16(3):330-8
17321163
Acta Orthop Scand. 2001 Aug;72(4):365-71
11580125
Int Orthop. 2008 Dec;32(6):759-65
17598111
J Shoulder Elbow Surg. 1998 Nov-Dec;7(6):586-90
9883418
Int Orthop. 2007 Oct;31(5):657-64
17033765
J Bone Joint Surg Am. 1970 Sep;52(6):1077-89
5455339
Int Orthop. 1998;22(5):316-20
9914936
J Bone Joint Surg Am. 1986 Oct;68(8):1136-44
3771595
Z Orthop Unfall. 2007 Mar-Apr;145(2):186-94
17492559
Injury. 2001 May;32 Suppl 1:SA25-32
11521703
J Shoulder Elbow Surg. 1999 Nov-Dec;8(6):569-73
10633890
J Shoulder Elbow Surg. 2007 Nov-Dec;16(6):774-81
17964817
Osteoporos Int. 2005 Mar;16 Suppl 2:S65-72
15526090
Clin Orthop Relat Res. 1987 Jan;(214):160-4
3791738
Orthopade. 1992 Apr;21(2):121-30
1594232
Clin Orthop Relat Res. 2006 Jan;442:87-92
16394745