title: Long-term results after non-plate head-preserving fixation of proximal humeral fractures.
abstract: 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.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany. C.Bahrs@gmx.de
authors.forename: Christian
authors.initials: C
authors.lastname: Bahrs
authors.forename: Andreas
authors.initials: A
authors.lastname: Badke
authors.forename: Bernd
authors.initials: B
authors.lastname: Rolauffs
authors.forename: Kuno
authors.initials: K
authors.lastname: Weise
authors.forename: Sebastian
authors.initials: S
authors.lastname: Zipplies
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Christoph
authors.initials: C
authors.lastname: Eingartner
mesh_terms: 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
references.citation: Orthopade. 1987 Aug;16(4):320-35
references.pmid: 3658415
references.citation: J Bone Joint Surg Am. 1992 Apr;74(4):508-15
references.pmid: 1583045
references.citation: J Bone Joint Surg Br. 1997 May;79(3):412-7
references.pmid: 9180319
references.citation: Int Orthop. 2006 Jun;30(3):153-7
references.pmid: 16622671
references.citation: J Bone Joint Surg Br. 2003 May;85(4):611-7
references.pmid: 12793573
references.citation: Chirurg. 2001 Nov;72(11):1235-45
references.pmid: 11766645
references.citation: Injury. 2001 Jun;32(5):363-72
references.pmid: 11382420
references.citation: J Trauma. 1996 May;40(5):778-83
references.pmid: 8614080
references.citation: J Shoulder Elbow Surg. 2007 May-Jun;16(3):330-8
references.pmid: 17321163
references.citation: Acta Orthop Scand. 2001 Aug;72(4):365-71
references.pmid: 11580125
references.citation: Int Orthop. 2008 Dec;32(6):759-65
references.pmid: 17598111
references.citation: J Shoulder Elbow Surg. 1998 Nov-Dec;7(6):586-90
references.pmid: 9883418
references.citation: Int Orthop. 2007 Oct;31(5):657-64
references.pmid: 17033765
references.citation: J Bone Joint Surg Am. 1970 Sep;52(6):1077-89
references.pmid: 5455339
references.citation: Int Orthop. 1998;22(5):316-20
references.pmid: 9914936
references.citation: J Bone Joint Surg Am. 1986 Oct;68(8):1136-44
references.pmid: 3771595
references.citation: Z Orthop Unfall. 2007 Mar-Apr;145(2):186-94
references.pmid: 17492559
references.citation: Injury. 2001 May;32 Suppl 1:SA25-32
references.pmid: 11521703
references.citation: J Shoulder Elbow Surg. 1999 Nov-Dec;8(6):569-73
references.pmid: 10633890
references.citation: J Shoulder Elbow Surg. 2007 Nov-Dec;16(6):774-81
references.pmid: 17964817
references.citation: Osteoporos Int. 2005 Mar;16 Suppl 2:S65-72
references.pmid: 15526090
references.citation: Clin Orthop Relat Res. 1987 Jan;(214):160-4
references.pmid: 3791738
references.citation: Orthopade. 1992 Apr;21(2):121-30
references.pmid: 1594232
references.citation: Clin Orthop Relat Res. 2006 Jan;442:87-92
references.pmid: 16394745