Fixation of proximal humerus fractures with precontoured, fixed angle devices has improved operative management of these difficult injuries, particularly in patients with osteoporosis. However, recent data has revealed that fixation with these constructs is not without complications, particularly screw cut-out and loss of reduction. Multiple strategies have been developed to decrease the number of complications. We offer a surgical technique combining suture augmentation of the proximal humerus with locked plate fixation utilizing short screws.
Bone Plates ; Bone Screws ; Fracture Fixation/*instrumentation/*methods ; Humans ; Shoulder Fractures/rehabilitation/*surgery

OBJECTIVETo investigate indication, technical key during surgery and early results of humeral head replacement for the treatment of complicated proximal humerus fractures.

METHODSSixteen patients who received humeral head replacement were reviewed with a mean follow-up period of 6.8 months. Of the 16 patients, 15 suffered acute fractures with the mean interval between injury and surgery being 8 days. 1 case was a malunion after ORIF 1 year ago. The mean age for these patients were 58.9 years. Trauma series X-rays were taken at post-operation 2-week, 6-week, 10-week, 16-week 6-month and the latest follow-up. 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 follow-up.

RESULTSThe mean ASES score was 89.1 (64 - 94); the mean VAS score was 2.7 (0 - 5); the mean forward flexion was 128.1 degrees (90 degrees - 150 degrees ), external rotation 35 degrees (30 degrees - 40 degrees ), internal rotation at T8-T9 level (L1-T6); the mean Constant-Murley score was 85.7 (53 - 95); the mean UCLA score was 30.4 (21 - 33); the mean number of questions for "yes" in SST questionnaire was 9.3 (7 - 11). The total satisfaction rate for pain relief was 93.8% (15/16), and functional recovery was 87.5% (14/16).

CONCLUSIONSThrough strict indication control, appropriate timing, meticulous surgical techniques and long intense rehabilitation, satisfactory results can be obtained in humeral head replacement for the treatment of complicated proximal humerus fractures. Our report is only a preliminary one on early results, and a long-term follow-up data is needed for further evaluation.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Shoulder Fractures ; physiopathology ; rehabilitation ; surgery