PROXIMAL HUMERAL FRACTURES - MANAGEMENT-TECHNIQUES AND EXPECTED RESULTS

During a ten-year period (1978-1988), 143 of 1386 patients with proxim al humeral fractures were treated with internal osteosynthesis. Ninety -seven proximal humeral osteosynthesis cases had adequate documentatio n, and 77 (80%) were available for clinical review. The 97 fractures w ere graded by the AO/ASIF classification and included 44 Group A, 32 G roup B, and 21 Group C fractures. Exercise-stable osteosynthesis using T-plate, cloverleaf plate, or small condylar plate was performed in 7 0% of patients. In the remaining patients, a less rigid fixation, with Kirschner wires or screws and cerclage wires, was used. Fifty-two per cent of the patients had excellent and good results, 15% had fair resu lts, and 33% had poor results. Most poor results occurred in patients with four-part fractures (61% of poor results). Of the cases involving four-part fractures, however, 22% had an excellent result after inter nal fixation. Displaced four-part fractures or fracture-dislocations s hould be treated by reconstruction of the proximal humerus, especially in young patients. The use of minimal fixation rather than rigid fixa tion is considered after careful assessment of the condition of the so ft tissue and blood supply of the humeral head fragments. Primary trea tment with endoprostheses is required when internal fixation is imprac tical in AO/ASIF fracture Types C 2/3 and C3 fractures. Improved clini cal results may be achieved, particularly in the more severe fracture types, with increased experience in techniques of internal fixation of proximal humeral fractures.