Outcomes of non-arthroplasty surgical treatment of proximal humeral head fractures.
OBJECTIVE
This study aimed to assess the outcomes of patients with humeral head fractures treated by reduction and osteosynthesis.


METHODS
A total of 53 shoulders (52 patients) with humeral head fractures were operated between October 1996 and December 2009. Patients previously treated with primary arthroplasty and/or those who had less than two years follow-up were excluded. A total of 34 shoulders of 34 patients were therefore reassessed. In the sample studied, 23 patients were male and mean age was 47 years. Cases were assessed based on the UCLA score.


RESULTS
Mean post-operative follow-up was 50 months. Twelve patients evolved with excellent outcome, seven good, five regular, and ten with poor outcome (55.8% satisfactory and 44.2% unsatisfactory outcomes). Mean UCLA score was 26 points. Mean post-operative range of motion measurements was 117° elevation, 36° LR and L1 MR. At the immediate post-operative radiography, anatomic reduction was evident in 17 patients (50%). Necrosis was detected in 18 patients, six Grade II and 12 Grade III cases. Female gender and anatomically reduced fractures were statistically better at UCLA scale (p= 0.01 andp= 0.0001 respectively).


CONCLUSIONS
Female patients had a higher mean UCLA score than male patients (p= 0.01). Anatomically reduced fractures had higher UCLA scores (p= 0.0001) and lower necrosis rate (p= 0.0001). Reconstruction of humeral head fractures had a satisfactory outcome in 55.8% of cases and should be indicated in young and active patients.
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Alberto Naoki
AN
Miyazaki
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Pedro Doneux
PD
Santos
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Guilherme do Val
GD
Sella
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Denis Cabral
DC
Duarte
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Giovanni Di
GD
Giunta
Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
Sergio Luiz
SL
Checchia
Adult; Epiphyses/injuries; Fracture fixation, internal; Shoulder fractures/surgery; Shoulder/surgery; Treatment outcome