Fractures of the proximal humerus

Overview

OBJECTIVE:
To evaluate function results in the group of patients with proximal humerus (PH) fractures operated in the Trauma Hospital of Brno and to compare results and possibilities of applied implants. Statistic evaluation of distribution of particular types of osteosynthese applicable for the therapy in PH fractures. The average time of hospitalisation and of healing were found out.

MATERIAL AND METHODS:
Patients included into this retrospective study were hospitalised in the Trauma Hospital of Brno for the fracture of proximal humerus in years 2011–2012. Some of these patients were operated after necessary preparation, the operation of the other was delayed, after failed conservative therapy.

RESULTS:
This group includes 173 surgically treated patients with PH fracture.The average hospitalisation time in patients treated by Phillos plate was 7,25 days, by nail 6,4 days, by miniosteosynthesis 5,1 days. The longest hospitalisation time was in patients with applied endoprosthesis of the shoulder joint, which answers to the fracture type, where the endoprosthesis was indicated. Two fragment fractures were operated in 43 patients, in this by miniosteosynthesis in 12 cases, intramedullary osteosynthesis in 25 cases and plate technique in 6 cases.

Three fragment fractures occured in 88 cases, most frequently in our group of patients. The cervicocapital prosthesis was implanted in 1 case, the Phillos plate in 50 cases, 37 patients were treated by intramedullary osteosynthese. Four fragment and luxation fractures occurred in our group in 42 patients, the cervicocapital prosthesis was implanted in 21 cases, the nail in 2 cases and the Phillos plate in 19 cases. The best results according to UCLA Score were achieved in two fragment fractures.

CONCLUSION:
The best results were demonstrated in miniosteosyntheses. The plate technique versus the nailing in PH fractures is applied approximately in a ratio of 1 : 1 in our hospital. The trend is the application of humeral nails also in three and four fragment fractures of the proximal humerus. The hospitalization time in intramedullary system of PH fracture stabilization is analogous to the plate technique, the screw protrusion into the glenohumeral joint occurred sporadically in both methods. According to our experience, the local complications occurre most frequently in plate applications.

Key words:
proximal humerus, stable ostheosynthesis.