[Surgical treatment of proximal humerus fractures--international multicenter study]

To receive an overview of the presently used methods for the operative treatment of fractures of the proximal humerus a prospective controlled multicenter study was arranged. 146 fractures from 145 patients (76 females, 69 men) were assessed, documented with the AO standard sheets and radiographs and with a one year follow-up examination. Each of the nine clinics used his own treatment scheme. They applied: K-wires (27%) for adaptation and for intramedullary fixation; tension band wires (16%) or sutures (11%) alone or in combination with K-wires; osteosynthesis with screws alone (7%) or with plates (22%). In 17% the humeral-head was acutely replaced with a prosthesis. 11 fractures (8%) had to be reoperated because of instability or loss of fixation. 109 patients were available for clinical review, one patient could be questioned by letter and six patients had died after one year (follow-up 80%). In 38% of patients full limb function was restored, slight impairment persisted in 45% and 17% remained severely handicapped. 96 fractures (89%) were consolidated, 30% with a deformity. 35% of patients still were unable to work full time. The treatment of fractures of the proximal humerus is generally difficult. More over the various operative methods and problematic fracture classification make a differentiate statistical analysis impossible. Still many questions remain. For answers a new trial is mandatory. For this future series fixed guidelines for indications and operative treatment modalities are required to allow a meaningful comparison of results and a scoring system for evaluation of functional outcome is necessary.