Treatment of 2- and 3-part fractures of the proximal humerus using external fixation: A retrospective evaluation of 62 patients

Abstract

Background Treatment of fractures of the humeral head remains controversial. We reviewed the outcome of our treatment of 2-and 3-part fractures of the proximal humerus using external fixation as a way of preventing damage to the vascularity of the humeral head and of reducing the risk of infection associated with open techniques.Method We retrospectively evaluated 2-and 3-part fractures of the humeral head, both clinically and radiographically, in 62 consecutive patients who were treated using external fixation. The mean follow-up time was 1.5 (1-2) years.Results The reduction was considered to be good in 50 cases, and 8 cases were consolidated in varus and 4 cases in valgus. The fracture healed in all patients. Except for 1 case of superficial infection around the screws and 1 redisplacement after a new fall, there were no early complications. Necrosis of the humeral head was not observed. 2 of the patients underwent shoulder replacement because of severe pain. The mean Constant score was 84 points, with satisfactory results (≥ 80 points) in 49 of the 62 patients. Sex, age, side, or type of fracture had no influence on the outcome.Interpretation This procedure provides satisfactory early functional results, simplifies rehabilitation by limiting postoperative motion to a lesser degree than other techniques, is less aggressive than open reduction techniques and osteosynthesis, and leads to few complications.

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

“…There are however, conflicting reports from different studies regarding use of external fixation as treatment modality for displaced proximal humeral fractures [5,[17][18][19][20][21][22][23]. Many studies in literature reports good or excellent results and less complication compared with open techniques [20][21][22][23], whereas some other studies reports state that external fixation and stabilization of proximal humeral fractures is technically demanding and can be used for two part 2-part proximal humeral fractures. External fixation also might lead to acceptance of less than optimal reduction as far as fracture stability is concerned, especially in elderly population with poor bone stock (osteoporosis) [5,[17][18][19].…”

“…Compared with open reduction and osteo-synthesis, external fixation techniques for displaced proximal humeral fractures avoid dissection and stripping of the soft tissues, leads to higher union rates, has a lower incidence of avascular necrosis, prevention of normal scapula humeral relation at its border and speedy rehabilitation [16,17]. There are however, conflicting reports from different studies regarding use of external fixation as treatment modality for displaced proximal humeral fractures [5,[17][18][19][20][21][22][23]. Many studies in literature reports good or excellent results and less complication compared with open techniques [20][21][22][23], whereas some other studies reports state that external fixation and stabilization of proximal humeral fractures is technically demanding and can be used for two part 2-part proximal humeral fractures.…”

“…All patients had informed and written consent obtained for the purpose of the study. The patients were informed about the benefits of external fixation and stabilization which included less invasiveness of the surgical procedure, minimal or less soft tissue dissection and almost no soft tissue stripping and the possible complications of external fixation which included loss of fracture reduction requiring more extensive surgery, pins migration and pin-tract infection; discomfort due to external fixator during the course of treatment [5,8,[16][17][18][19][20][21][22][23]. The present study was approved by ethical committee of institution.…”

“…There are very few reported studies in literature regarding external fixation of displaced proximal humeral fractures [5,[16][17][18][19][20][21][22][23]. Compared with open reduction and osteo-synthesis, external fixation techniques for displaced proximal humeral fractures avoid dissection and stripping of the soft tissues, leads to higher union rates, has a lower incidence of avascular necrosis, prevention of normal scapula humeral relation at its border and speedy rehabilitation [16,17].…”

Hackethal Bundle Nailing with Intramedullary Elastic Nails in the Treatment of Two- and Three-Part Fractures of the Proximal Humerus: Initial Experience at Al Razi Hospital, Kuwait

“…The problems involved in treatment decisions include type of fracture, bone quality and general condition of the patient. Several methods, including conservative treatment, variable forms of fixation, and hemiarthroplasty have been proposed, but the long-term results have not always been satisfactory, and a new interest in finding a better therapeutic solution has been observed in recent years [3][4][5][6][7][8][9] . The introduction of locking plates with better fixation stability has improved…”