Abstract | UNLABELLED: METHODS: We retrospectively analysed 22 proximal humeral fractures in 21 patients; 10 were male and 11 female with an average age of 64.6 years (range 37-77). Average follow-up was 24 months. Eleven of these fractures were exposed by the extended deltoid-splitting approach. Fractures were classified according to Neer and Hertel systems. Preoperative radiographs and computed tomography (CT) scans in three- and four-part fractures were done to assess the displacement and medial calcar length for predicting the humeral head vascularity. According to the Neer classification, there were five two-part, six three-part, five four-part fractures and six fracture-dislocations (two anterior and four posterior). Results were assessed clinically with disabilities of the arm, shoulder and hand (DASH) scores, modified Constant and Murley scores and serial postoperative radiographs. RESULTS: The mean DASH score was 16.18 and the modified Constant and Murley score was 64.04 at the last follow-up. Eighteen out of twenty-two cases achieved good clinical outcome. All the fractures united with no evidence of infection, failure of fixation, malunion, tuberosity failure, avascular necrosis or adverse reaction to calcium sulphate bone substitute. There was no evidence of axillary nerve injury. Four patients had a longer recovery period due to stiffness, associated wrist fracture and elbow dislocation. The CaSO4 bone substitute was replaced by normal appearing trabecular bone texture at an average of 6 months in all patients. CONCLUSION: In our experience, we have found the use of locking plates, calcium sulphate bone substitute and tuberosity repair with high-strength sutures to be a safe and reliable method of internal fixation for complex proximal humeral fractures and fracture-dislocations. Furthermore, we have also found the use of the extended deltoid-splitting approach to be safe and to provide excellent exposure facilitating accurate reduction for fixation of the fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations.
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Authors | K Somasundaram, C P Huber, V Babu, H Zadeh |
Journal | Injury
(Injury)
Vol. 44
Issue 4
Pg. 481-7
(Apr 2013)
ISSN: 1879-0267 [Electronic] Netherlands |
PMID | 23199758
(Publication Type: Journal Article)
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Copyright | Copyright © 2012 Elsevier Ltd. All rights reserved. |
Chemical References |
- Bone Substitutes
- Calcium Sulfate
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Topics |
- Adult
- Aged
- Axilla
(diagnostic imaging, innervation)
- Bone Plates
- Bone Substitutes
(therapeutic use)
- Calcium Sulfate
(therapeutic use)
- Female
- Follow-Up Studies
- Fracture Fixation, Internal
(methods)
- Fracture Healing
- Humans
- Male
- Middle Aged
- Orthopedic Procedures
- Pain Measurement
- Patient Positioning
- Radiography
- Range of Motion, Articular
- Recovery of Function
- Retrospective Studies
- Shoulder Fractures
(diagnostic imaging, physiopathology, surgery)
- Treatment Outcome
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