Treatment of 2- and 3-part fractures of the proximal humerus using external fixation: a retrospective evaluation of 62 patients.

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.

METHOD

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.

INTERPRETATION

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.