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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 12, 1602-1607.
doi: 10.1302/0301-620X.90B12.20269  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients

R. Bogner, MD, Trauma Surgeon1; C. Hübner, MD, Trauma Surgeon1; N. Matis, MD, Trauma Surgeon1; A. Auffarth, MD, Trauma Surgeon1; S. Lederer, MD, Trauma Surgeon1; and H. Resch, MD, Professor1

1 Department of Traumatology and Sports Injuries University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.

Correspondence should be sent to Dr R. Bogner; e-mail: R.Bogner{at}salk.at

The surgical treatment of three- and four-part fractures of the proximal humerus in osteoporotic bone is difficult and there is no consensus as to which technique leads to the best outcome in elderly patients. Between 1998 and 2004 we treated 76 patients aged over 70 years with three- or four-part fractures by percutaneous reduction and internal fixation using the Humerusblock.

A displacement of the tuberosity of > 5 mm and an angulation of > 30° of the head fragment were the indications for surgery.

Of the patients 50 (51 fractures) were available for follow-up after a mean of 33.8 months (5.8 to 81). The absolute, age-related and side-related Constant scores were recorded. Of the 51 fractures, 46 (90.2%) healed primarily. Re-displacement of fragments or migration of Kirschner wires was seen in five cases. Necrosis of the humeral head developed in four patients. In three patients a secondary arthroplasty had to be performed, in two because of re-displacement and in one for necrosis of the head. There was one case of deep infection which required a further operation and one of delayed healing.

The mean Constant score of the patients with a three-part fracture was 61.2 points (35 to 87) which was 84.9% of the score for the non-injured arm. In four-part fractures it was 49.5 points (18 to 87) or 68.5% of the score for the non-injured arm.

The Humerusblock technique can provide a comfortable and mobile shoulder in elderly patients and is a satisfactory alternative to replacement and traditional techniques of internal fixation.




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 J Bone Joint Surg BrHome page
F. Kralinger, S. Unger, M. Wambacher, V. Smekal, and W. Schmoelz
The medial periosteal hinge, a key structure in fractures of the proximal humerus: A BIOMECHANICAL CADAVER STUDY OF ITS MECHANICAL PROPERTIES
J Bone Joint Surg Br, July 1, 2009; 91-B(7): 973 - 976.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General