Outcomes for open reduction and internal fixation of 4-part proximal humeral fractures

Abstract

Objective To discuss the indications of plate fixation of 4-part proximal humeral fractures (PHFs) and evaluate the clinical results. Methods From Feburary 2004 to September 2007 twenty-one patients who sustained 4-part PHFs were treated by open reduction and plate internal fixation. The patients were classified into three groups according to Neer classification. There were 11 patients, whose ages were (53.4±9.3) years, in the abduction impacted 4-part PHFs group, 6 patients in the typical 4-part PHFs group with an average age of (55.8±4.5) years, and 4 patients in the 4-part fracture-dislocation group with an average age of (52.5 ± 3.7 ) years. Constant- Murley score (CMs) and simple shoulder test (SST) were used to assess shoulder function. Results Nineteen patients were available for follow up while two patients in the abduction impacted 4-part group were lost to follow-up. The mean follow-up period for the the abduction impacted 4- part PHFs group was (28.1±15.4 ) months. Their mean CMs was ( 81.0 ± 7.3 ), and SST was (9.6±1.0). CMs of the typical 4-part PHFs group was(72.2±9.4), while SST was (8.3± 1.5). They were followed up for (31.2±14.2) months on average. Greater tubercle absorption appeared in one patient in this group and his CMs and SST was 59.0 and 7.0 respectively. Patients of the fracture- dislocation group were followed up for(22.0±18.5) months. Their CMs was(40.5±11.2) and SST was (4.7±1.6). One patient in this group had humeral head osteonecrosis, two patients had greater tubercle absorption, and one suffered both. Conclusion Selection of proper treatment procedures is critical in the management of 4-part proximal humeral fractures. ORIF is an effective treatment for younger patients with abduction impacted fractures. For typical 4-part and fracture-dislocation PHFs anatomical reduction and rigid fixation are required.