Outcome of surgical treatment of proximal humerał fracture

Abstract

Glenohumeral joint movement dysfunction, often caused by proximal humeral fracture, limits daily activity. Proximal fracture of the humerus is a common injury which constitutes 5.7% of all fractures in trauma patients. The aim of the study was the retrospective evaluation of results of surgical treatment of proximal humeral fracture in accordance to fracture type and applied treatment. The study group consisted of 70 patients who had undergone surgery due to proximal humeral fracture. The mean age in the study group was 55.2 years. The patients were classified according to the AO/ASIF system, based on the preoperative X-ray in comparison to the operative X-ray image. The patients were treated with five methods (ORIF – LCP-type plate, ORIF – AO-type plate, ORIF – AO screw(s), CRIF – intramedullary nailing, CRIF – „K” wires). The average time of follow-up amounted to 19.4 months. The function of the glenohumeral joint was assessed after surgery applying the Constant-Murley scale. The analysis of treatment outcomes showed that in patients operated on for proximal humeral fracture type A and B, the percentage of results described as very good and good was comparable and amounted to approximately 50%. In the smallest group of patients with the most complex type C fractures, a good and very good result was observed only in 14.29% of the subjects. The analysis did not show statistically significant differences in treatment results (p>0.05). Multiple comparisons showed that regardless of the fracture type, patients received a similar score on the Constant-Murley scale. Osteosynthesis using LCP plates and angular stabile screws does not improve the treatment outcome in any type of the proximal humeral fracture. However, LCP plates and angular stable screws are used as a standard management for the most severe cases of proximal humeral fracture. Because of a many available treatment techniques, qualification for a particular treatment method should be considered individually for every patient.