167 patients with fracture dislocations of the proximal humerus--operated upon between 1970 and 1980--were followed up on an average 43.2 months after the accident. Fractures were classified according to Neer in two-part-(n = 24), three-part-(n = 60) and four-part-fractures (n = 61) as well as fractures of the articular surface (n = 21). 20.4% of all fractures were complicated by a neurological lesion. In 31% of all cases a good or excellent result was obtained. The functional result and the rate of avascular head necrosis were dependent on the type of fracture, that means the number of displaced parts. Results after 23 head prostheses were disappointing. The analysis of functional results and the rate of avascular head necrosis after different types of operation proved that minimal fixation with K-wire or tension-band was slightly superior to plate fixation.

In this paper late results of 65 proximal humeral fractures, operated upon between 1970 and 1980 are reported. Fractures were classified according to Neer in two-part-(28), three-part-(15), four-part-fractures (21) and fractures of the articular surface (1). In 34 cases internal fixation was performed by a T-plate. In 15 cases either open reduction without internal fixation or open reduction and minimal internal fixation was done using screws and K-wires. Primary prosthetic replacement of the head was done in 8 patients with four-part-fractures. The follow-up period ranged from 2.5 years up to 13 years with an average of 7 years. The functional results were excellent in 25 patients, good in 14, fair in 10 and poor in 16 patients. Better results were obtained in young patients, isolated shoulder injuries and patients with two- or three-part-fractures. On the contrary the results in aged and polytraumatized patients or patients with four-part-fractures and fracture dislocations were less favourable. Avascular necrosis of the humeral head was encountered in 4 cases of four-part-fractures and fracture dislocations, 3 of them fixed by T-plate and 1 by minimal internal fixation. No case of avascular necrosis of the humeral head was encountered in two- or three-part-fractures, fixed by T-plate. We can conclude, that cases, having a high risk for developing avascular necrosis of the humeral head, i.e. four-part-fractures and fracture dislocations, are better treated with minimal internal fixation avoiding the use of T-plate, for it was found to increase the already present damage.

Neurological complications in clavicle fractures are rare. As a primary lesion, it is caused by the trauma itself, more often the neurological symptoms develop later by large callus formation to encroach the costoclavicular space. Neurological complications early after trauma are mostly caused by the figure-of-eight bandage generally used for conservative treatment. Vascular lacerations as well as fractures of the first two ribs have to be excluded. We report about a case of complete brachial nerve paralysis two days after conservative treatment of an uncomplicated clavicle fracture.

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We report about our first experience in 16 patients with femoral neck fractures, operated upon with the dynamic hip screw. All fractures united within three to six months, early avascular necrosis did not occur. In the concept of treatment of femoral neck fractures osteosynthesis with dynamic hip screw has some advantage, especially compared with the AO-nail plate: Easy correction of the guide wire position, sufficient impaction of the fragments by using the compression screw, low risk of penetration into the acetabulum during fracture healing with shortening of the femoral neck.