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Shoulder function after displaced fractures of the proximal humerus
K Zyto1, M Kronberg, L A Broström
1Department of Orthopaedics, Södersjukhuset, Stockholm, Sweden.
Journal of Shoulder and Elbow Surgery
|September 1, 1995
Summary
Outcomes for three-part proximal humerus fractures are generally good, with most patients accepting their shoulder situation. Four-part fractures show significantly lower range of motion and higher rates of complications like humeral head necrosis and osteoarthrosis.
Area of Science:
- Orthopedic surgery
- Traumatology
- Biomechanics
Background:
- Predicting outcomes for comminuted proximal humerus fractures is challenging.
- Optimal treatment guidelines and postoperative evaluation scoring systems are needed.
Purpose of the Study:
- To assess the functional outcome of three- and four-part proximal humerus fractures.
- To evaluate treatment modalities and patient-reported outcomes over a 3-year follow-up.
Main Methods:
- Clinical and radiographic examination of 38 patients with proximal humerus fractures.
- Utilized Neer and Constant scoring systems for postoperative evaluation.
- Compared outcomes between three-part (n=26) and four-part (n=11) fracture groups, with varied treatments.
Main Results:
- Three-part fractures generally had good functional outcomes, with 25/26 patients accepting their shoulder situation.
- Four-part fractures exhibited significantly lower range of motion (mean flexion 89° vs. 120°) and higher complication rates.
- Humeral head necrosis occurred in 2 four-part fractures; osteoarthrosis developed in 13 cases (6 three-part, 7 four-part).
Conclusions:
- Three-part proximal humerus fractures typically yield favorable functional results.
- Four-part fractures are associated with poorer range of motion and increased risk of avascular necrosis and osteoarthritis.
- The Constant score strongly correlates with patient-reported satisfaction.