Results of surgical treatment of multifragmented fractures of the humeral head.

This paper reports the results of 27 multifragmented fractures of the proximal humerus treated between 1972 and 1976. Only 3- and 4-part fractures as well as fracture dislocations were included. Internal fixation was performed in 17 cases with buttress plates and in 10 patients by minimal fixation with a tension band wire or simple lag screw. On an average of 3.5 years postoperatively out of 27 patients eight had excellent, eight a good, six a fair, and five a poor overall result. Radiologically six cases of avascular necrosis of the humeral head (22.2%) were detectable in one 3-part, four 4-part and one fracture dislocation. Five times necrosis was observed after plate fixation (34%) once after wiring of the greater tuberosity. The incidence of unfavorable head necrosis is dependent on the primary fracture type. The results point to the fact that further damage due to surgery and its risk to the remaining blood supply is less prominent in gentle exploration and minimal osteosynthesis than with a generous exposure needed for plate fixation. Minimal fixation thus should be preferred.