External fixation for displaced 2-part proximal humeral fractures

Studies have reported conflicting results regarding external fixation for displaced proximal humeral fractures. Compared with open reduction and internal fixation, external fixation for displaced proximal humeral fractures avoids dissection and soft tissue stripping and leads to higher union rates, a lower incidence of avascular necrosis, less scaring of the scapulohumeral interface, and faster rehabilitation. Some authors have reported good or excellent results and minimum complications compared with open reduction and internal fixation; however, others have reported that external fixation does not ensure acceptable reduction and fracture stability, especially in patients with osteoporosis.This article describes 18 patients with displaced 2-part fractures of the surgical neck of the humerus treated with closed reduction and external fixation using the Tension Guide Fixator (Gexfix SA, Carouge, Switzerland) external fixation system between 2010 and 2011. The patients included 14 women and 4 men with a mean age of 39 years. Mean follow-up was 18 months (range, 15-24 months). Fracture union; function using the Constant score, University of California Los Angeles score, Oxford score, and Quick Disabilities of the Arm, Shoulder and Hand shoulder score; and complications were evaluated. All patients experienced fracture union at a mean of 11 weeks (range, 9-13 weeks). The Tension Guide Fixator was removed without anesthesia at the outpatient clinic at a mean of 6 weeks (range, 4-8 weeks) with no loss of reduction or secondary displacement after removal. At 1-year follow-up, mean Constant and University of California Los Angeles scores were excellent, mean Oxford score showed satisfactory joint function, and mean Quick Disabilities of the Arm, Shoulder and Hand score showed minimal pain with no disability.