Locking plates and semi-shoulder arthroplasty for complex proximal humeral fractures

ObjectiveTo explore the clinical effects and indications of locking plates and semi-shoulder arthroplasty for complex proximal humeral fractures. Methods Thirty-nine cases of proximal humeral fractures were treated from January 2005 to December 2008. They were 12 men and 27 women, with a mean age of 65.1 years. According to Neer classification, there were 23 cases of two-part fracture, 10 cases of three-part fracture, and 6 cases of four-part fracture. Patients with two-part fracture and an age of ＜ 60 years were treated with open reduction and internal fixation (ORIF) with proximal humeral intemal locking system(PHILOS) . Patients with three-part fracture were treated with ORIF and arthroplasty. Patients with four-part fracture and an age of ＞ 60 years were treated with arthroplasty. Altogether, ORIF was performed in 32 cases (23 in two-part fractures and 9 in three-part fractures). Arthroplasty was performed in 7 cases (one in three-part fracture and 6 in four-part fractures).Results In the ORIF group, the average surgical time was 84 minutes (from 60 to 140 minutes) and the average blood loss was 155 mL (from 100 to 400 mL). In the arthroplasty group, the average surgical time was 125 minutes (from 100 to 170 minutes) and the average blood loss was 220 mL (from 150 to 450 mL). The average follow-up was 23 months (from 16 to46 months)for the 39 cases. No complications were found. X-ray showed 28 fractures were healed in 3 months and 4 were healed in 6 months after operation. The Disabilities of the Arm, Shoulder and tand(DASH) scores averaged 20.7 points for the ORIF group (from 10 to 42 points) and 36. 0 points for the arthroplasty group (from 18 to 52 points).ConclusionIn treatment of proximal humeral fractures, patients with two-part fracture and aged ＜ 60 years can be managed by ORIF, patients with three-part fracture can be managed by ORIF and semi-shoulder arthroplasty, and patients with four-part fracture and aged ＞ 60 years can be managed by semi-shoulder arthroplasty. Key words: Shoulder fractures; Bone plates; Fracture fixation, internal; Arthroplasty, replacement