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Open Reduction and Internal Fixation of Three and Four-Part Fractures of the Proximal Part of the Humerus

Investigation performed at the Department of Orthopaedics, Academic Medical Center, Amsterdam, The Netherlands

A.J. Wijgman, MD
W. Roolker, PhD
T.W. Patt, MD, PhD
E.L.F.B. Raaymakers, MD, PhD
R.K. Marti, MD, PhD
Department of Orthopaedics, Academic Medical Center, G-4, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address for A.J. Wijgman: ajwijgman{at}knmg.nl E-mail address for R.K. Marti: orthopaedie@amc.uva.nl

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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Background: Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and the functional limitations of patients in whom avascular necrosis of the humeral head develops as a complication of this fracture.

Methods: We assessed the intermediate and long-term results for sixty patients with a three or four-part fracture of the proximal part of the humerus who had undergone open reduction and internal fixation with cerclage wires or a T-plate. The Constant score and a visual analog score for pain were calculated, and radiographs of the proximal part of the humerus were evaluated.

Results: After an average of ten years of follow-up, fifty-two patients (87%) had a good or excellent result on the basis of the Constant score whereas eight patients (13%) had a poor result. Fifty-one patients (85%) were satisfied with the result at the time of the most recent examination. Twenty-two patients (37%) had development of avascular necrosis of the humeral head, and seventeen (77%) of these twenty-two patients had a good or excellent Constant score.

Conclusions: Open reduction and internal fixation with cerclage wires or a T-plate yields good functional results in most patients. This option should be considered even for patients with fracture-dislocation patterns that are associated with a high risk for avascular necrosis of the humeral head, as this complication did not preclude a good result.

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