Evaluation of various methods treatment of proximal humerus fractures.

Background. Most of the proximal humerus fractures are osteoporotic and concern elderly patients. In the literature long-term results of treatment of proximal humerus fractures are poor or fair. Objective. The objective of the paper was to present various methods of treatment - conservative and surgical. Material and method. A group of 138 fractures of proximal humerus fractures treated during years 1988-1999 was analysed. 84 (63%) fractures were followed up for a period ranging from 18 months to 10 years. Results were estimated by Neer's criteria. Results. The worst results in conservative treatment were obtained when Desault plaster cast was used (47% poor and fair); the best when sling was used (75% very good and good). Among the surgical methods the best results were observed thanks to fixation with threaded Kirschner wires (86% very good and good); the worst when screw or plate and screw fixation was used (60% poor). Conclusions. 1. For two- and three-part fractures with dislocation in which proper heeling augurs well, the right method of fixation is stabilisation with threaded Kirschner wires. 2. Treatment to be chosen for fractures without dislocation is the sling and early rehabilitation (1-2 weeks after trauma), whereas treatment in Desault plaster cast should be regarded as a mistake. 3. In elderly patients with four-part fractures, haemiarthroplasty as a primary operation should be considered.