Abstract
Objective
To report the functional and radiological results of unusual comminuted fractures of the proximal humerus, treated with ‘closed reduction and external fixation’ (CREF) using hybrid-type unilateral external fixators (EFs).
Patients and methods
Between January 2012 and June 2013, eight patients (mean age 62.6; range 48–84 years) with comminuted proximal humeral fractures extending to the humeral head and one-third proximal diaphysis were treated with CREF using hybrid-type EFs. Functional results were evaluated in terms of shoulder ranges of movement, Constant, DASH, and VAS scores, and radiological results were evaluated using antero-posterior and lateral radiograms of the treated humerus.
Results
The mean follow-up was 16.6 (range 12–28) months. The mean fixator time was 84 (range 63–118) days. The mean range of forward flexion, internal rotation, external rotation, and abduction were 145°, 61.2°, 65°, and 115°, respectively. The mean Constant, DASH, and VAS scores were 79.8, 10, and 1.75, respectively. Seven of the eight patients (87.5 %) healed radiologically. Two complications were observed in two patients: non-union and superficial pin site infection.
Conclusions
In the treatment of unusual, comminuted proximal diaphyseal humeral fractures, CREF using a hybrid-type EF is a minimally invasive, advantageous procedure with acceptable rates of healing, low risk of surgical site infection, and early range of motion.
Level of evidence
Level IV, case series.
Similar content being viewed by others
References
Brunner A, Thormann S, Babst R (2012) Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS). J Shoulder Elbow Surg 21(8):1056–1063. doi:10.1016/j.jse.2011.05.016
Handoll HH, Gibson JN, Madhok R (2003) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 4:CD000434. doi:10.1002/14651858.CD000434
Flatow E (2001) Fractures of the proximal humerus. In: Bucholz R, Heckman JD (eds) Fractures in adults, 5th edn. Lippincot Williams & Wilkins, Philadelphia, pp 997–1040
Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M (2011) Humeral shaft fractures: a review. J Shoulder Elbow Surg 20(5):833–844. doi:10.1016/j.jse.2010.11.030
Broadbent MR, Quaba O, Hadjucka C, McQueen MM (2003) The epidemiology of multifocal upper limb fractures. Scand J Surg 92(3):220–223
Lewicky YM, Sheppard JE, Ruth JT (2007) The combined olecranon osteotomy, lateral paratricipital sparing, deltoid insertion splitting approach for concomitant distal intra-articular and humeral shaft fractures. J Orthop Trauma 21(2):133–139. doi:10.1097/01.bot.0000245988.23684.79
O’Donnell TM, McKenna JV, Kenny P, Keogh P, O’Flanagan SJ (2008) Concomitant injuries to the ipsilateral shoulder in patients with a fracture of the diaphysis of the humerus. J Bone Joint Surg Br Vol 90(1):61–65. doi:10.1302/0301-620X.90B1.19215
Garnavos C, Lasanianos N (2010) Intramedullary nailing of combined/extended fractures of the humeral head and shaft. J Orthop Trauma 24(4):199–206. doi:10.1097/BOT.0b013e3181b2b74d
Heim D, Herkert F, Hess P, Regazzoni P (1993) Surgical treatment of humeral shaft fractures: the Basel experience. J Trauma 35(2):226–232
An Z, He X, Zeng B (2009) A comparative study on open reduction and plating osteosynthesis and minimal invasive plating osteosynthesis in treating mid-distal humeral shaft fractures. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi =Chin J Reparative Reconstr Surg 23(1):41–44
Stedtfeld HW, Biber R (2014) Proximal third humeral shaft fractures: a fracture entity not fully characterized by conventional AO classification. Injury 45(Suppl 1):S54–S59. doi:10.1016/j.injury.2013.10.030
Hasegawa T, Inufusa A, Imai Y, Mikawa Y, Lim TH, An HS (2005) Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J 5(3):239–243. doi:10.1016/j.spinee.2004.11.010
Neer CS 2nd (1987) Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res 223:3–10
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium—2007: orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133
Maresca A, Pascarella R, Bettuzzi C, Amendola L, Politano R, Fantasia R, Del Torto M (2014) Multifocal humeral fractures. Injury 45(2):444–447. doi:10.1016/j.injury.2013.10.010
Benetos IS, Karampinas PK, Mavrogenis AF, Romoudis P, Pneumaticos SG, Vlamis J (2012) External fixation for displaced 2-part proximal humeral fractures. Orthopedics 35(12):e1732–e1737. doi:10.3928/01477447-20121120-17
Ziran BH, Smith WR, Anglen JO, Tornetta P III (2008) External fixation: how to make it work. Instr Course Lect 57:37–49
Catagni MA (2003) Atlas for the insertion of transosseous wires and half-pins Ilizarov method. In: Malocchi AB (ed) Medi Surgical Video. Italy, Milan
Moroni A, Faldini C, Pegreffi F, Giannini S (2004) HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures. Clin Orthop Relat Res 425:87–92
Crates J, Whittle AP (1998) Antegrade interlocking nailing of acute humeral shaft fractures. Clin Orthop Relat Res 350:40–50
Modabber MR, Jupiter JB (1998) Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res 347:93–104
Ingman AM, Waters DA (1994) Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results. J Bone Joint Surg Br Vol 76(1):23–29
Reimer B (1998) Humeral shaft fractures-intramedullary nailing. In: Wiss D (ed) Master techniques in orthopaedic surgery. Lippincott-Raven, Philadelphia, pp 81–94
Chiu FY, Chen CM, Lin CF, Lo WH, Huang YL, Chen TH (1997) Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma 43(6):947–951
Castella FB, Garcia FB, Berry EM, Perello EB, Sanchez-Alepuz E, Gabarda R (2004) Nonunion of the humeral shaft: long lateral butterfly fracture—a nonunion predictive pattern? Clin Orthop Relat Res 424:227–230
Yang KH (2005) Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury 36(1):75–80. doi:10.1016/j.injury.2004.03.023
Mostafavi HR, Tornetta P 3rd (1997) Open fractures of the humerus treated with external fixation. Clin Orthop Relat Res 337:187–197
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uzer, G., Yıldız, F., Elmadağ, M. et al. Treatment of unusual proximal humeral fractures using unilateral external fixator: a case series. Eur J Orthop Surg Traumatol 25, 683–687 (2015). https://doi.org/10.1007/s00590-014-1579-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-014-1579-9