Double plating for obsolete proximal humeral fractures with instability of medial metaphysis

Abstract

Objective To evaluate the results of double plating for obsolete proximal humeral fractures whose instability of medial metaphysis cannot be maintained conventionally.Methods From January 2005 to June 2012,we treated 10 patients with the obsolete proximal humeral fracture mentioned above with double plating.They were 6 men and 4 women,aged from 26 to 51 years (average,38.8 years).The fractures involved 8 principal sides (all right sides).By the Neer classification,7 cases were two-part varus fractures of surgical neck,one three-part fractures of greater tubercle,and 2 four-part fractures (non-abduction compact ones).The range of motion of the shoulder,visual analogue scale (VAS),American Shoulder and Elbow Score (ASES),Constant-Murley score,University of California-Los Angeles (UCLA) score and Simple Shoulder Test (SST) were all recorded for functional evaluation.The results were compared between preoperation and the last follow-up.Results The 10 patients were followed up for an average of 16.9 months (from 12 to 50 months).At the last follow-up,the forward flexion was 144.0° ± 30.6°,external rotation 34.5° ±27.2° and internal rotation up to T10 level on average.The Constant-Murley score was 84.4 ± 12.9,ASES 79.5 ± 20.2,UCLA 28.7 ± 5.1,SST 9.6 ± 1.7,and VAS 1.7 ± 2.5.By Constant evaluation,8 patients considered the results as excellent and the other 2 as good.There were significant differences between preoperation and the last follow-up regarding all the above indexes in the 10 obsolete fractures (P ＜ 0.05).Ischemic necrosis of the humeral head occurred in 2 cases and delayed union in one.No other complications were observed.Conclusion Double plating can lead to satisfactory outcomes in treatment of obsolete proximal humeral fractures whose instability of medial metaphysis cannot be maintained conventionally. Key words: Shoulder fractures; Fracture fixation, internal; Bone plates; Range of motion,articular