Failures of Operative Treatment of Comminuted Fractures of Proximal Humerusin in Own Material

BACKGROUND: Fractures of the proximal humerus make up 4 to 10% of all fractures. Their incidence increaseswith age, usually affecting individuals over 40 years old, reflecting the mineral status of the bone, Material and methods. Out of a group of 131 patients operated on due to comminuted proximal humeral fractures, 25 cases presenting inappropriate postoperative results were selected for further analysis. RESULTS: Failures were found in 16 cases, but affected the final outcome in seven cases only (lack of anatomical repositioning of bone fragments, including one that was stabilized at the fifth postfracture week, in whom a severe contracture of the supraspinatus muscle dislocated the major tubercle, or conflict of the implant with the acromion), and were negligible in the other nine. In two, properly stabilized major tubercles were dislocated due to their bearing the body weight immediately after the procedure. Another two developed necrosis of the humeral head, and in one the fracture was revealed to be pathological, requiring further oncological treatment. In four cases, ostensible false stabilizations were recorded as a consequence of inappropriate patient positioning for x-rays. CONCLUSIONS: 1. Our observations indicate that anatomical repositioning of bone fragments, especially those containing articular surface and muscle attachments, and their firm stabilization as well as proper implant positioning are crucial for the final result. 2. In some cases objective and unpredictable factors influencing the type and time of intervention affect the final results. 3. In those cases the decision to operate seems to be controversial. 4. The possibility of a pathological fracture should also be remembered, as such fractures require an appropriate oncological treatment.