Locked plate osteosynthesis of humeral head–splitting fractures in young adults

Abstract

Humeral head-splitting fractures occur in younger patients and can be associated with poor outcome. We decided to study the functional outcome and complications in simple and complex humeral head-splitting fractures. We hypothesized that simple head-splitting fractures will perform better compared with complex head-splitting fractures. Records of 16 patients <55years who underwent locked plating for humeral head-splitting fractures were reviewed. Five fractures were classified as simple (isolated head-splitting fractures) and 11 as complex fractures (associated tuberosity fractures). Union and quality of articular and tuberosity reduction were assessed radiologically. Shoulder and upper limb function was assessed by Constant and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Complications such as osteonecrosis, nonunion, and arthritic changes were also recorded. Of 15 fractures, 13 had united at a mean follow-up of 34months (25-47months). No osteonecrosis or nonunion was seen in simple fractures. In complex fractures, osteonecrosis was seen in 4 patients (P=.01), nonunion in 2 patients, and glenohumeral arthritis in 1 patient. The mean Constant score (66.5 [56-77]) and DASH score (21 [7.5-35.8]) showed significantly better outcomes in simple fractures (Constant score, P=.02; DASH score, P=.029). Locked plating achieves satisfactory results in simple head-splitting fractures. Complex fractures are associated with higher rates of nonunion, avascular necrosis, and inferior shoulder function.