Surgical Treatment of the Unstable Fractures of the Proximal Humerus: Consideration of Surgery-related Problems and Complications

Kim, In; Woo, Young Kyun; Chang, Ju Hae; Kim, Hyung Min; Kim, Yong Sik; Kwon, Soon Yong; Kim, Yang Su

Abstract

Authors reviewed and analyzed the 96 cases of the unstable proximal humerus fracture surgically managed in the department of orthopaedic surgery of Catholic University Medical College from 1981 to 1993. Analysis dealt with the fracture classification, the clinical assessment, surgical method and related complication, operative result. The overall results were as follows 1. According to the classification by Neer (1970),46 cases were 2 part fracture, 16 cases 3 part fracture,24 cases 4 part fracture,8 cases fracture -dislocation and 2 cases head splitting fracture; of 8 cases of fracture-dislocation,2 cases(3part-1/4part-1) were the iatrogenic displaced cases during manual reduction of 2 part fracture-dislocation. 2. The surgical methods were as follows; for fracture fixation of 80 cases, buttress T-plate in 48 cases, Rush pin and wire in 9 cases, cancellous screw and wire in 8 cases, Steinmann pin and wire 8 cases, Seidle nail in 3 cases, Herbert screw and wire in 1 case and Steinmann pin in 1 case were used respectively. Herbert screw was used in 6 cases for major or supplementary fixation. And joint replacement in 16 cases(14 hemiarthroplasty/2 total arthroplasty ) were performed. 3. The Operative results were analyzed with postoperative radiograph 1) Of 80 cases of open reduction; adequate reduction in 51 cases, inadequate reduction in 21 cases(varus-9, valgus-4, malreduction of greater tuberosity-4, highly located implant-3, excessive shortening-1), insufacient fixation in 5 cases, joint penetration of screw in 2 cases, iatrogenic shaft fracture in 1 case. 2) Of 16 cases joint replacement; adequate replacement in 12 cases, improper fixation or management of greater tuberosity in 3 cases, inappropriate retrotorsion of humeral component in 1 case. 4. Functional assessment by Neers method was done as follows: Of 80 cases open reduction group, excellent and satisfactory results in 59 cases, unsatisfactory and failure results in 21 cases. of 16 cases joint replacement group, satisfactory results in 10 cases and unsatisfactory results in 6 cases. 5. Complications occurred as follows: 1) Of 80 cases of open reduction; malunion with joint stiffness 26 cases, impingement in 4 cases, fixation loss in 3 cases, axillary nerve palsy, distant pin migration and avascular necrosis of humeral head in each 1 case. 2) Of 16 cases of joint replacement; joint stiffness in 7 cases, loosening of humeral component in 4 cases, nonunion of greater tuberosity and axillary nerve in each 1 case.