[4-fragment fracture of the proximal upper arm]

Four-fragment fractures have to be accorded great importance because they are so severe. The morphology allows differentiation of two types, the dorsolateral fracture type and the impacted fracture type. Over a 4-year time span, 13 of these fractures were treated with minimal osteosynthesis. This involve the open anatomical reduction and allogeneic spongiosa grafting and retention of the fracture with screws and, if necessary, K-wires and tension banding. After an average of 26.3 months the shoulder function was evaluated using the CONSTANT score. The dorsolateral fractures were scored of 87.2 while the impacted fractures were scored at 88.8. No necrosis of the humeral head was found. These good results show that after four-fragment fractures primary reconstruction of the humeral head should be preferred over primary prosthetic replacement.