title: Treatment of unusual proximal humeral fractures using unilateral external fixator: a case series.
abstract: OBJECTIVE
  To report the functional and radiological results of unusual comminuted fractures of the proximal humerus, treated with 'closed reduction and external fixation' (CREF) using hybrid-type unilateral external fixators (EFs).
  
  
  METHODS
  Between January 2012 and June 2013, eight patients (mean age 62.6; range 48-84 years) with comminuted proximal humeral fractures extending to the humeral head and one-third proximal diaphysis were treated with CREF using hybrid-type EFs. Functional results were evaluated in terms of shoulder ranges of movement, Constant, DASH, and VAS scores, and radiological results were evaluated using antero-posterior and lateral radiograms of the treated humerus.
  
  
  RESULTS
  The mean follow-up was 16.6 (range 12-28) months. The mean fixator time was 84 (range 63-118) days. The mean range of forward flexion, internal rotation, external rotation, and abduction were 145°, 61.2°, 65°, and 115°, respectively. The mean Constant, DASH, and VAS scores were 79.8, 10, and 1.75, respectively. Seven of the eight patients (87.5 %) healed radiologically. Two complications were observed in two patients: non-union and superficial pin site infection.
  
  
  CONCLUSIONS
  In the treatment of unusual, comminuted proximal diaphyseal humeral fractures, CREF using a hybrid-type EF is a minimally invasive, advantageous procedure with acceptable rates of healing, low risk of surgical site infection, and early range of motion.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakıf University, Vatan Cd., Fatih, 34093, Istanbul, Turkey.
authors.forename: Gökçer
authors.initials: G
authors.lastname: Uzer
authors.forename: Fatih
authors.initials: F
authors.lastname: Yıldız
authors.forename: Mehmet
authors.initials: M
authors.lastname: Elmadağ
authors.forename: Kerem
authors.initials: K
authors.lastname: Bilsel
authors.forename: Anil
authors.initials: A
authors.lastname: Pulatkan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome