Treatment of War Trauma Fractures of the Proximal Humerus

Abstract

Summary A war wound to the proximal humerus is characterised by profuse bleeding, multifragmentary fracture-dislocations, defects of the muscle tissue, capsule, skin and by primary contamination with polymorphic bacterial flora, and it is rarely isolated. Out of 27 injured people, subluxation/dislocation of the humeral head occured in the first four patients who suffered a proximal humeral fracture resulting from a warrelated trauma stabilized with an external fixator. Two pins were inserted into the humeral head, and the other two into the diaphysis. In the other wounded people, there was no subluxation/dislocation of the humerus because the pins were placed into the clavicle, into the acromion or spinous process of the scapula. Out of the 27 patients treated for proximal humeral injuries, the contact was established with 11. Out of these 11 patients, only in one patient we did not use the clavicle, the acromion or spinous process of the scapula to stabilize the fracture. The result of the treatment was poor due to avascular necrosis of the head and ankylosis of the shoulder. In the ten remaining patients we used 'temporary' placement of a pin into the clavicle or into the acromion or spinous process of the scapula. The final outcome of the treatment was satisfactory. The average Constant score was 59 points. There is little data in professional literature about injuries to the proximal humerus caused by war-related trauma. The most commonly used system of classification of peacetime traumas is the Neer or AO classification system as there are balanced algorythms in the protocol for treating the trauma. Proximal humeral fractures should be stabilized with an external fixator, inserting one pin into the clavicle or into the acromion or scapular spine. This prevents the subluxation/dislocation of the humeroscapular joint and facilitates early mobilisation, and thus improves the clinical result and reduces complications.