Subgroups and differences of fixation in 3-part proximal humerus fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Bone Healing

Background:

• Three-part proximal humerus fractures are common and frequently treated with plate screw fixation.
• Morphological variations within these fractures necessitate subgroup-specific treatment strategies.

Purpose of the Study:

• To determine morphological differences in three-part proximal humerus fractures.
• To evaluate functional and radiological outcomes of surgical methods applied to different fracture subgroups.

Main Methods:

• Twenty-nine patients with three-part proximal humerus fractures were categorized into three groups based on fracture type.
• Surgical intervention involved a minimally invasive deltoid split approach with locked anatomical plate screw osteosynthesis.
• Specific techniques included cortico-cancellous allografts (Group 1), no grafting (Group 2), and metaphyseal compression (Group 3).
• Functional outcomes were assessed using the Constant Murley score, and radiological outcomes via cephalodiaphyseal angle (CDA).

Main Results:

• All 29 patients achieved bone union within an average of 3.6 months, with an average follow-up of 27.6 months.
• Excellent or good functional results were reported in 29 out of 29 patients (24 excellent, 5 good).
• Cephalodiaphyseal angle (CDA) showed a statistically significant difference between Groups 2 and 3 in final follow-up.

Conclusions:

• Subgroup-specific surgical approaches, including grafting for valgus-impacted fractures and metaphyseal compression for unstable fractures, yield comparable functional outcomes to stable three-part fractures.
• Evaluation and treatment of Neer type 3 fractures should consider distinct subgroups.
• Tailored fixation and stability-enhancing solutions are essential for optimizing outcomes in different three-part proximal humerus fracture subgroups.