Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus.

Lukas F Heilmann,Helmut Lill,J Christoph Katthagen,Rony-Orijit Dey Hazra,Hassan El Bajjati,Benedikt Schliemann,Michael J Raschke,Gunnar Jensen

doi:10.3390/jcm10173841

Lukas F Heilmann, Helmut Lill + Show 6 more

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https://doi.org/10.3390/jcm10173841

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Abstract

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.

Highlights

Proximal humeral fractures account for 4–5% of all fractures [1]
Out of the 24 fractures that matched inclusion criteria, follow-up data was collected for 19 fractures (79.2%; Table 2)
The most important finding of this study is that humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus yields a good clinical outcome

Summary

Introduction

Proximal humeral fractures account for 4–5% of all fractures [1]. The age distribution is bimodal, with fragility fractures being more common in the elderly, while high-velocity trauma fractures tend to occur in younger patients [1,2]. Among those, locked dislocated fractures of the proximal humerus are rare, as previous studies were able to show [4,5] Within this cohort of locked dislocation fractures of the humerus, there are generally two fracture sub-groups concerning the direction of dislocation: the more common anterior dislocation of the fractured humeral head (AFD), which accounts for over 90% of cases, and the rarer posterior fracture dislocation (PFD) [3,6]. The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment

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