4-PART FRACTURES OF THE PROXIMAL HUMERUS - ALTERNATIVE STRATEGIES FOROPERATIVE TREATMENT

The operative treatment of dislocated fractures of the proximal humeru s has been evolving in recent years. Replacement using endoprostheses often results in only moderate functional outcome,and with the high ri sk of aseptic necrosis with ORIF,new methods of minimally invasive sta bilisation have been developed. These methods reduce the opening of th e fracture site to a minimum and thereby limit the risk of iatrogenic damage to local vascularity and the rotator cuff. This study reviewed 18 patients operated on with minimal osteosynthesis for dislocated fou r-part fractures of the proximal humerus from March 1991 to October 19 94. Only tension band wiring with resorbable cords from woven polydiox anone was applied. After an average follow-up of 26 months (20 - 37 mo nths), 72% (n = 13) of the four-part fractures were rated as good and very good results according to the Neer Score. In 16.7%, a complete he ad necrosis occurred, requiring a prosthetic replacement. Two patients with partial necrosis (11.1%) had a good functional outcome. With reg ard to these results, we recommend head-preserving tension band wiring with resorbable cords and preservation of the articular surface. At t he present time the procedure seems comparable with prosthetic replace ment in respect of shoulder function.