OBJECTIVESTo compare the indication, technical keys during surgery and early results of humeral head replacement and internal fixation for the 3 parts and 4 parts fractures of proximal humerus in the elderly.

METHODSFrom July. 2004 to July. 2006,58 patients with 3 parts and 4 parts fractures of proximal humerus were randomly treated with AO locked compressive plates (LCP) or humeral head replacement. In LCP group, there were 12 males and 16 females with an average age of (66.5 +/- 1.4) years, including 24 cases of 3 parts fractures, 1 case of 3 parts fractures with dislocation, 2 cases of 4 parts fractures and 1 case of 4 parts fractures with dislocation. In the humeral head replacement group,there were 12 males and 18 females with an average age of (68.9 +/- 3.5) years, including 9 cases of 3 parts fractures, 2 cases of 3 parts fractures with dislocation, 12 cases of 4 parts fractures, 4 cases of 4 parts fractures with dislocation and 3 cases of humeral head split fractures. Trauma series X-rays of shoulder were taken after operation, 2-week, 6-week, 10-week, 16-week, 6-month and the latest followed-up. VAS, SST (simple shoulder test) questionnaire, ASES (American shoulder & elbow surgeon)score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest followed-up.

RESULTSThe mean followed-up period of LCP group was 29.8 months and that of humeral head replacement group was 28.2 months. VAS of LCP group and humeral head replacement group were (2.2 +/- 1.5) and (2.6 +/- 1.9), respectively. There was a statisticaly difference between the two groups (P = 0.002). The degrees of forward elevation of shoulder in LCP group and humeral head replacement group were 110.2 degrees (81 degrees to 130 degrees) and 120.2 degrees (89 degrees to 140 degrees), respectively. There was a statistical difference between the two groups (P = 0.031). ASES score, Constant-Murley score, UCLA score and response "yes" in SST questionnaire in LCP group were 87.7 +/- 2.2, 83.9 +/- 6.8, 30.3 +/- 2.2, 8.0 +/- 0.9, and in humeral head replacement group were 86.4 +/- 4.5, 85.5 +/- 5.6, 31.2 +/- 2.1, 9.0 +/- 0.7, respectively. There was no significant difference between the two groups in ASES score, Constant-Murley score, UCLA score and SST questionnaire.

CONCLUSIONBoth humeral head replacement and internal fixation are effective treatment for the 3 parts and 4 parts fracture of proximal humerus in the elderly. Humeral head replacement is more technically demanding and has a strict indications. The satisfactory results of humeral head replacement are based on the suitable placement of prostheses and the correct reconstruction of rotator cuff insertion.