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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 4, 502-508.
doi: 10.1302/0301-620X.88B4.17195  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation

C. M. Robinson, FRCSEd(Orth), Consultant Orthopaedic Surgeon1; L. A. K. Khan, BSc(Hons), MRCSEd, Specialist Registrar1; and M. A. Akhtar, MRCSEd, Senior House Officer1

1 The Shoulder Injury Clinic, The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SU, UK.

Correspondence should be sent to Mr C. M. Robinson; e-mail: c.mike.robinson{at}ed.ac.uk

Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury).

Following treatment by open reduction and internal fixation, only two of 23 patients with type-I injuries developed radiological evidence of osteonecrosis of the humeral head, compared with four of seven patients with type-II injuries.

A policy of primary treatment by open reduction and internal fixation of type-I injuries is justified, whereas most elderly patients (aged 60 years or over) with type-II injuries are best treated by hemiarthroplasty. The best treatment for younger patients (aged under 60 years) who sustain type-II injuries is controversial and an individualised approach to their management is advocated.






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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General