[Late results following the surgical treatment of proximal humerus fractures in adults].

In this paper late results of 65 proximal humeral fractures, operated upon between 1970 and 1980 are reported. Fractures were classified according to Neer in two-part-(28), three-part-(15), four-part-fractures (21) and fractures of the articular surface (1). In 34 cases internal fixation was performed by a T-plate. In 15 cases either open reduction without internal fixation or open reduction and minimal internal fixation was done using screws and K-wires. Primary prosthetic replacement of the head was done in 8 patients with four-part-fractures. The follow-up period ranged from 2.5 years up to 13 years with an average of 7 years. The functional results were excellent in 25 patients, good in 14, fair in 10 and poor in 16 patients. Better results were obtained in young patients, isolated shoulder injuries and patients with two- or three-part-fractures. On the contrary the results in aged and polytraumatized patients or patients with four-part-fractures and fracture dislocations were less favourable. Avascular necrosis of the humeral head was encountered in 4 cases of four-part-fractures and fracture dislocations, 3 of them fixed by T-plate and 1 by minimal internal fixation. No case of avascular necrosis of the humeral head was encountered in two- or three-part-fractures, fixed by T-plate. We can conclude, that cases, having a high risk for developing avascular necrosis of the humeral head, i.e. four-part-fractures and fracture dislocations, are better treated with minimal internal fixation avoiding the use of T-plate, for it was found to increase the already present damage.