Two-part fractures of the proximal humerus.

Between 1981 and 1991, 137 patients had 141 two-part proximal humerus fractures. One hundred thirteen surgical neck, 24 greater tuberosity, 2 anatomic neck, and 2 lesser tuberosity fractures were studied. Eleven patients had died in the interim; the remaining cases were reviewed. The mean age of patients with surgical neck fractures was 57 years (range 20 to 91 years), and 62.8% (71 cases) were women. In 38% of cases there was another significant medical problem. Eighty (70.8%) cases were treated with a sling and early isometric and pendulum exercises. Bony union was obtained in an average of 3.2 months (range 2 to 8 months), and 87.5% achieved satisfactory function. The mean age of patients with greater tuberosity fractures was 37 years (range 20 to 59 years), and 79.2% (19 cases) were men. Ten (41.7%) cases were treated with open reduction and internal fixation, and the remainder were treated without surgery. All patients improved to a satisfactory level of function. Anatomic neck fractures (two) were treated with surgery. Lesser tuberosity fractures (two) were treated conservatively and had good functional results. It appears that conservative measures when coupled with early isometric and pendulum exercises produce a satisfactory result in surgical neck fractures. Similarly, conservative treatment for nondisplaced greater tuberosity fractures and operative intervention for displaced fractures resulted in satisfactory function. Lesser tuberosity fractures without limitation of motion appear to do well with a sling and early motion.