[Osteosynthesis in dislocated fractures of the humerus head]

The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration to a great extent the biological aspects of these fractures and provides sufficient stability for early functional therapy. Neer's classification has proved very useful for both the indication for and the choice of an operative procedure. The high necrosis rate of the operatively stabilized humeral head has considerably influenced the operative strategy. This is shown in two separately controlled patient groups. From 1970 to 1980, 65 patients and from 1983 to 1987, 30 patients with displaced fractures of the proximal humerus were treated operatively. Within the first group, in more than half the cases a T-plate osteosynthesis was performed, a minimal osteosynthesis being performed in only 1 out of 5 patients. In the second group, we exclusively performed minimal osteosynthesis. More favourable results were achieved in fractures with two or three fragments, in younger patients and in isolated shoulder injuries than with four-fragment fractures or luxated fractures, in older and in polytraumatized patients. Using minimal osteosynthesis instead of plate osteosynthesis in four-fragment fractures, functional results were achieved which, in 75%, were satisfactory or better. The necrosis rate of the humeral head also declined. We conclude that head-preserving methods seem advisable in these severe forms of humeral fractures.