Skip to main content
SpringerLink
Log in

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

  • Symposium: Fractures of the Shoulder Girdle
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.

Questions/purposes

We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates.

Patients and Methods

We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period. Three- and four-part fractures were treated surgically while one-part fractures were treated nonoperatively. Functional scores, ROM, and radiographs were used to evaluate outcomes. American Shoulder and Elbow Surgeons and SF-36 scores were obtained at 12 months. Of the 142 patients, 101 (51 with three- or four-part fractures and 50 with one-part fractures) had a minimum followup of 12 months (average, 19 months; range, 12–64 months).

Results

The fractures united in all patients. At 1 year, the patients with one-part fractures had better SF-36 physical and mental scores and American Shoulder and Elbow Surgeons scores than the three- and four-part fractures. Both groups had similar shoulder ROM. Nine patients treated operatively had complications, four of which were related to screw penetration into the joint.

Conclusions

Patients with three- and four-part fractures should be advised of the likelihood of persistent functional impairment and a relatively higher risk of complications when treated operatively with locked plates.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–F

Similar content being viewed by others

References

  1. Agudelo J, Schurmann M, Stahel P, Helwig P, Morgan SJ, Zechel W, Bahrs C, Parekh A, Ziran B, Williams A, Smith W. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma. 2007;21:676–681.

    Article  PubMed  Google Scholar 

  2. Antuna SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg. 2008;17:202–209.

    Article  PubMed  Google Scholar 

  3. Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741–745.

    Article  PubMed  Google Scholar 

  4. Clifford PC. Fractures of the neck of the humerus: a review of the late results. Injury. 1980;12:91–95.

    Article  PubMed  CAS  Google Scholar 

  5. Cruess RL. Corticosteroid-induced osteonecrosis of the humeral head. Orthop Clin North Am. 1985;16:789–796.

    PubMed  CAS  Google Scholar 

  6. Dietrich M, Meier C, Lattmann T, Zingg U, Gruninger P, Platz A. [Complex fracture of the proximal humerus in the elderly: locking plate osteosynthesis vs hemiarthroplasty] [in German]. Chirurg. 2008;79:231–240.

    Article  PubMed  CAS  Google Scholar 

  7. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.

    Article  PubMed  Google Scholar 

  8. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176–181.

    Article  PubMed  Google Scholar 

  9. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21:185–191.

    Article  PubMed  Google Scholar 

  10. Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86:848–855.

    Article  PubMed  CAS  Google Scholar 

  11. Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD. Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Shoulder Elbow Surg. 1995;4:81–86.

    Article  PubMed  CAS  Google Scholar 

  12. Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008;39:306–313.

    Article  PubMed  Google Scholar 

  13. Horak J, Nilsson BE. Epidemiology of fracture of the upper end of the humerus. Clin Orthop Relat Res. 1975;112:250–253.

    Article  PubMed  Google Scholar 

  14. Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res. 2006;442:115–120.

    Article  PubMed  Google Scholar 

  15. Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79:203–207.

    PubMed  CAS  Google Scholar 

  16. Kristiansen B, Christensen SW. Proximal humeral fractures: late results in relation to classification and treatment. Acta Orthop Scand. 1987;58:124–127.

    Article  PubMed  CAS  Google Scholar 

  17. Krivohlavek M, Lukas R, Taller S, Sram J. [Use of angle-stable implants for proximal humeral fractures: prospective study] [in Czech]. Acta Chir Orthop Traumatol Cech. 2008;75:212–220.

    PubMed  CAS  Google Scholar 

  18. Lill H, Hepp P, Rose T, Konig K, Josten C. [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach—technique and first results] [in German]. Zentralbl Chir. 2004;129:43–48.

    Article  PubMed  CAS  Google Scholar 

  19. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L. Fracture and Dislocation Classification Compendium-2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma. 2007;21:S1–S133.

    Article  PubMed  CAS  Google Scholar 

  20. Neer CS 2nd. Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res. 1987;223:3–10.

    PubMed  Google Scholar 

  21. Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90:233–240.

    Article  PubMed  Google Scholar 

  22. Plecko M, Kraus A. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol. 2005;17:25–50.

    Article  PubMed  Google Scholar 

  23. Sallay PI, Reed L. The measurement of normative American Shoulder and Elbow Surgeons scores. J Shoulder Elbow Surg. 2003;12:622–627.

    Article  PubMed  Google Scholar 

  24. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91:1689–1697.

    Article  PubMed  Google Scholar 

  25. Strohm PC, Helwig P, Konrad G, Sudkamp NP. Locking plates in proximal humerus fractures. Acta Chir Orthop Traumatol Cech. 2007;74:410–415.

    PubMed  CAS  Google Scholar 

  26. Tejwani NC, Liporace F, Walsh M, France MA, Zuckerman JD, Egol KA. Functional outcome following one-part proximal humeral fractures: a prospective study. J Shoulder Elbow Surg. 2008;17:216–219.

    Article  PubMed  Google Scholar 

  27. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.

    Article  PubMed  Google Scholar 

  28. Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.

    PubMed  Google Scholar 

  29. Zuckerman JD, Matsen FA 3rd. Complications about the glenohumeral joint related to the use of screws and staples. J Bone Joint Surg Am. 1984;66:175–180.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Robert Meislin, MD, Laith Jazrawi, MD, and Nirmal Tejwani, MD, for allowing us to include their patients in our study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th Street, New York, NY, 10003, USA

    Crispin Ong MD, Christopher Bechtel BA, Michael Walsh PhD, Joseph D. Zuckerman MD & Kenneth A. Egol MD

Authors
  1. Crispin Ong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Bechtel BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Walsh PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph D. Zuckerman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenneth A. Egol MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth A. Egol MD.

Additional information

Each author certifies that he/she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his/her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of our institutional ethical review board and that informed consent was obtained from all participants.

About this article

Cite this article

Ong, C., Bechtel, C., Walsh, M. et al. Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures. Clin Orthop Relat Res 469, 3292–3299 (2011). https://doi.org/10.1007/s11999-011-1864-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1864-4

Keywords

Search

Navigation