The crossed screw osteosynthesis of proximal humeral fractures

Between March 1997 and October 1999 thirty-one patients with displaced prox imal humeral fractures were treated with crossed screw osteosynthesis. Inse rtion of the screws was realized by using a deltoideo-pectoral approach pla cing the screws anteriorly and posteriorly in a crossed manner from the dis tal fragment into the humeral head. Additionally, in all two-part-fractures a tension band was applied. in all three-part-fractures, the greater tuber osity was reattached by additional screws. In 21 patients (14 female, 7 mal e, median age 62 years, 18-86) a clinical and radiological follow-up (media n 18 months, 10-29) was obtained. Fractures were classified as two-part-fra ctures in 10 patients and as three-part-fractures in 11 patients. According to the Constant-Score, "excellent" and "good" results were achieved in 15 patients,"moderate" results were found in 3 patients. However, in 3 patient s results were only "poor" (1 two-part-, 2 three-part-fractures).The compli cation rate was 29% (premature hardware removal due to head perforation in 3 cases; humeral head necrosis necessitating prosthetic replacement in 2 pa tients; secondary displacement in 1 case). Crossed screw osteosynthesis rep resents an justified alternative in the surgical treatment of displaced pro ximal humeral fractures permitting early functional therapy.