The Journal of Bone and Joint Surgery, Vol 68, Issue 9 1410-1414, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
The three-part fracture of the proximal part of the humerus. Operative treatment
RJ Hawkins, RH Bell and K Gurr
A retrospective review of the cases of fifteen patients with a three-part
fracture of the proximal part of the humerus is presented. Fourteen of the
fractures were treated with tension-band wiring and one, with an AO
buttress plate. The patients were evaluated for pain, range of motion,
strength, and function of the involved shoulder and the radiographic result
at an average of fifty-four months after the injury. At follow-up, the
shoulders had an average of 126 degrees of active elevation, 29 degrees of
active external rotation, 81 degrees of active abduction, and internal
rotation to the second lumbar vertebra. The only early complication was
failure of fixation in the patient who had been treated with a buttress
plate. In two patients, radiographic evidence of avascular necrosis of the
humeral head later developed, and one of them required revision to a
hemiarthroplasty. In conclusion, we recommend operative treatment for the
healthy, active individual who has a three-part fracture of the proximal
part of the humerus. We found that the best results with these difficult
fractures are obtained using tension-band wiring.
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