A Clinical Analysis on Operative Treatment of Displaced Proximal Humeral Fracture

Kang, Chang Soo; Pyun, Young Sik; Sung, Chul Soo; Ko, Soon Bong; Kang, Goo Tae

Abstract

Most proximal humeral fractures respond satisfactory to simple conservative treatment. But operative treatment is recornmended in the cases that poor results are anticipated by prolonged immobilization, or because of the severe displacement and comminution. After Neer. in 1970, emphasized the need for operative treatment in displaced proximal humeral fractures, many papers reported better results with the operative management. Twenty five cases of displaced fractures and fracture dislocations of the proximal humerus treated at the department of orthopaedic surgery, Keimyung University with open reduction and internal fixation were analyzed clinically and radiologically. The following results were obtained. 1. The prevalent age distribution was the second snd third decades(average 42.6 years) and ratio of male and female was 2.1: 1. 2. In 10 of the 25 cases, wire loop was used for internal fixation, and the result was satisfactory in 8 cases. However, the disadvantage was difficulty in wire removal after bony union because the loop was buried in the callus or cortex. 3. Over-all results were excellent or satisfactory in 64% of 25 cases. There were 4 excellent and 1 satisfsctory in 5 cases of type Il fracture, 7 excellent, 2 satisfactory and 3 unsatisfactory in 12 cases of type III fracture, 1 excellent and 4 unsatisfactory in 5 cases of type 1V fracture, and 1 excellent, 1 unsatisfactory and 1 failure in 3 cases of fracture dislocation. 4. In 6 patients with four part lesions treated with open reduction and internal fixation and followed up for an average of 23 months(from 18 months to 3 years and 2 months), only one case of fracture dislocation revealed avascular necrosis with resorption of the head.