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[Corrective interventions subsequent to humeral head fractures]
1Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Der Orthopade
|April 1, 1992
Summary
For old proximal humeral fractures, osteotomies are effective alternatives to shoulder arthroplasty, especially before arthritis develops. Internal fixation for nonunion also offers a viable option, potentially replacing hemiarthroplasty.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Shoulder Reconstruction
Background:
- Old proximal humeral head fractures and fracture dislocations can lead to complications like nonunion, malunion, osteonecrosis, arthritis, and instability.
- These complications necessitate surgical intervention to restore shoulder function.
Purpose of the Study:
- To evaluate the outcomes of different surgical treatments for old proximal humeral fractures and fracture dislocations.
- To compare the effectiveness of arthroplasty versus osteotomy and internal fixation techniques.
Main Methods:
- A consecutive series of 34 shoulders treated between 1986 and 1990 were reviewed.
- Group I: 17 patients underwent 7 hemiarthroplasties and 11 total shoulder arthroplasties (Neer type).
- Group II: 12 patients had osteotomies, 3 had internal fixation for nonunion (AO technique), and 1 had shoulder arthrodesis.
Main Results:
- Group I (arthroplasty) showed 32% good, 50% fair, and 18% poor results.
- Group II (osteotomy/fixation) showed 6% excellent, 62% good, and 32% fair results.
- Average follow-up was 27 months for Group I and 26 months for Group II.
Conclusions:
- Varus/valgus and derotation osteotomies are viable alternatives to arthroplasty, particularly before the onset of traumatic arthritis.
- Internal fixation for nonunion (AO technique) is an effective alternative to hemiarthroplasty.