Journal of Musculoskeletal Trauma

Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports: Sam Guk Park; J Korean Fract Soc 2016;29(1):61-67. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.61

Some proximal humeral fractures in elderly patients are accompanied by medial metaphyseal comminution and quality of the bone is so poor that head preserving osteosynthesis seems to be amenable. In cases of medial metaphyseal comminution, lateral locking compression plate (LCP) fixation also has a tendency to become a matter of screw cut out or loss of fixation. The author reports on successful treatment of two osteoporotic proximal humeral fractures combined with medial meta-physeal comminution, with application of additional direct medial supporting plate fixation. Medial plate fixations were added when the fractures were still unstable after the conventional lateral LCP fixation and anterior circumflex humeral arteries had been ruptured before. The fixations were stable enough to start exercise immediately after surgery. The inclinations of the humeral neck were not changed until the last follow-up and clinical results were satisfactory without humeral head osteonecrosis which was a concern.

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Dual-Plate Fixation for Proximal Humerus Fractures With Unstable Medial Column in Patients With Osteoporosis
Hyun-Gyu Seok, Sam-Guk Park
Journal of Orthopaedic Trauma.2023; 37(10): e387. CrossRef
The plate fixation strategy of complex proximal humeral fractures
Qi Sun, Xiaoming Wu, Lei Wang, Ming Cai
International Orthopaedics.2020; 44(9): 1785. CrossRef
Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support
Yu He, Yaoshen Zhang, Yan Wang, Dongsheng Zhou, Fu Wang
Journal of Orthopaedic Surgery and Research.2017;[Epub] CrossRef

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Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis: Youn Soo Hwang, Kwang Yeol Kim, Hyung Chun Kim, Su Han Ahn, Dong Eun Lee; J Korean Fract Soc 2013;26(1):14-20. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.14

Abstract PDF

PURPOSE
To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail.
MATERIALS AND METHODS
Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score.
RESULTS
All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points.
CONCLUSION
The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.

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Surgical Management of Osteoporotic Fractures: Humerus Shaft Fractures
Shankar Ramaprasad Kurpad
Indian Journal of Orthopaedics.2025;[Epub] CrossRef

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Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus: Chul Hyun Cho, Gu Hee Jung, Kyo Wook Kim; J Korean Fract Soc 2011;24(3):237-242. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.237

Abstract PDF: PURPOSE
To evaluate the results of antegrade interlocking intramedullary nailing for complex fractures of the proximal and midshaft of the humerus.
MATERIALS AND METHODS
We retrospectively analyzed the clinical and radiologic results in 11 cases, which were treated by antegrade interlocking intramedullary nail. We assessed clinical outcomes according to ASES scoring system and radiological result.
RESULTS
All cases had bony union and the mean union period was 14.7 weeks. Postoperative complications were 1 loss of fixation, 2 proximal protrusion of nail and 2 temporary shoulder pain. A case with loss of fixation was treated open reduction and refixation and had union at 14 weeks postoperatively. The mean ASES score was 85.9 and the clinical outcomes were 4 excellent, 5 good, 1 fair and 1 poor.
CONCLUSION
Intramedullary nailing for complex fractures of the proximal and midshaft of the humerus can offer a reliable treatment option.

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Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing: A Case Report: Jae Hyuk Shin, Ho Guen Chang, Young Woo Kim, Nam Kyou Rhee, Yong Bok Park, Yong Kuk Kim; J Korean Fract Soc 2011;24(2):185-190. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.185

Abstract PDF

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

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Locking compression plate fixation of periprosthetic distant humeral fracture after intramedullary nail for humeral shaft fracture: A case report
Mei-Ren Zhang, Kui Zhao, Jiang-Long Guo, Hai-Yun Chen
Trauma Case Reports.2022; 37: 100565. CrossRef
Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture
Hiren M. Divecha, Hans A. J. Marynissen
Case Reports in Orthopedics.2013; 2013: 1. CrossRef

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Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture: Doo Sup Kim, Dong Kyu Lee, Chang Ho Yi, Jang Hee Park, Jung Ho Rah; J Korean Fract Soc 2011;24(2):144-150. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.144

Abstract PDF

PURPOSE
Authors compare clinical and radiological results of internal fixation group and hemiarthroplasty group for comminuted proximal humerus fracture to find out which the treatment method have to be chose for comminuted proximal humerus fractures.
MATERIALS AND METHODS
Patients who were treated from March 2005 to March 2007 and available for 2 years follow-up were targets of this study. The internal fixation group had 38 cases, and hemiarthroplasty group included 26 cases. The results were analyzed both clinically and radiologically.
RESULTS
On average, Bone union took 15.6 weeks in the internal fixation group. Constant score between the internal fixation and hemiarthroplasty groups were on average 75+/-6.5 points and 70+/-7.4 points (p=0.034). In 3-part fracture, Constant score between both groups were 78+/-5.4 points from the former and 71+/-2 points, respectively (p=0.028). In 4-part fracture group, Constant score were 72+/-8 points for the internal fixation group and 69+/-9.2 points for the hemiarthroplasty group (p=0.041).
CONCLUSION
Internal plate fixation can gain better outcome than hemiarthroplasty in 4-part fracture as well as 3-part fracture of proximal humerus by careful dissection for preservation of blood supply for humeral head and optimal reduction.

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Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis
Erik Hohmann, Natalie Keough, Vaida Glatt, Kevin Tetsworth
European Journal of Orthopaedic Surgery & Traumatology.2022; 33(6): 2215. CrossRef
Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review
Long Chen, Fei Xing, Zhou Xiang, Ara Nazarian
PLOS ONE.2016; 11(11): e0166801. CrossRef
Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures
Jiezhi Dai, Yimin Chai, Chunyang Wang, Gen Wen
European Journal of Orthopaedic Surgery & Traumatology.2014; 24(3): 305. CrossRef

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Conservative Treatment of Valgus Impacted Four-Part Fracture of the Proximal Humerus: A Case Report: Moon Chan Kim, Jae Lim Cho, Hung Tae Chung, Dong Jun Kim, In Bo Kim; J Korean Fract Soc 2011;24(1):96-99. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.96

Abstract PDF: For valgus impacted four part fracture of the proximal humerus, surgical stabilization and early mobilization of the joint can produce the best clinical outcomes. But, we have experienced a case of conservative treatment and gained good clinical results. We have reported this case and included a review of the relevant literatures.

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Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures: Chung Hee Oh, Joo Han Oh, Sae Hoon Kim, Ki Hyun Jo, Sung Woo Bin, Hyun Sik Gong; J Korean Fract Soc 2008;21(3):213-219. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.213

Abstract PDF

PURPOSE
To evaluate the outcome of hemiarthroplasty with bone block graft and low profile prosthesis (Aequalis(R) fracture prosthesis) for the comminuted proximal humerus fractures.
MATERIALS AND METHODS
Sixteen low profile prostheses were used since July 2004, and 11 patients were followed-up for average 19.9 (12~30) months. Their mean age was 67.3 (52~78) years. Pain and satisfaction visual analog scale (VAS), range of motion, and modified UCLA score for hemiarthroplasty were evaluated at every visit. Radiography was also checked for stem position, loosening, and tuberosity union.
RESULTS
Mean pain VAS was 2.7 (0~5), and mean satisfaction VAS was 8.4 (5~10). Mean active forward flexion was 137 degrees (90~170), external rotation at side was 45.5 degrees (25~70), and internal rotation at back was T10 (T7~L1). Modified UCLA score was 19 (12~30) at final visit. All stems were stable, and there were no loosening at the final follow-up. All tuberosities were united except two tuberosity absorptions.
CONCLUSION
The outcome of hemiarthroplasty with bone block graft and low profile prosthesis was comparable to other implants for comminuted proximal humerus fractures. This system had unique advantages for tuberosity union. Further study with more patients and longer follow-up are necessary to clarify the effectiveness of this prosthesis.

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A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus
Sung-Weon Jung
Journal of the Korean Fracture Society.2013; 26(1): 8. CrossRef
Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture
Doo-Sup Kim, Dong-Kyu Lee, Chang-Ho Yi, Jang-Hee Park, Jung-Ho Rah
Journal of the Korean Fracture Society.2011; 24(2): 144. CrossRef

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Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture: Jin Oh Park, Jin Young Park, Sung Tae Lee, Hong Keun Park; J Korean Fract Soc 2007;20(1):45-52. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.45

Abstract PDF

PURPOSE
To evaluate the results according to the difference of age and bone mineral density (BMD) of the surgical treatments using open intramedullary nail with tension sutures and lock suture on proximal humeral three part fracture.
MATERIALS AND METHODS
30 patients treated by open intramedullary nail with tension band and lock suture technique on proximal humeral fractures were reviewed. After treatment, average follow up periods was 50 months (range; 17~143 month). Postoperative clinical outcome was evaluated using ASES functional score, Neer score and constant score.
RESULTS
Bony union were obtained all except one case. Range of motion, mean forward elevation was 142Â°, mean external rotation was 56Â°, mean external rotation at 90Â° abduction was 68Â°. Average pain score of visual analog scale was 1.5. Average functional score of American Shoulder and Elbow Society was 86. Average Neer score was 89. Constant score was 85. Pain and functional score of group I were better than those of group, however, there was no statistically significant difference (p>0.05). In the comparison between group III and group IV, the results were same (p>0.05).
CONCLUSION
The patients treated using open intramedullary nailing, tension band and lock suture could enable early ROM exercise and show good clinical results. This treatment method will be useful in old age osteoprorotic patients.

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Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures
Chung Hee Oh, Joo Han Oh, Sae Hoon Kim, Ki Hyun Jo, Sung Woo Bin, Hyun Sik Gong
Journal of the Korean Fracture Society.2008; 21(3): 213. CrossRef

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The Treatement of the Unstable Proximal Humerus Fracture Using Bifurcate Angled Blade Plate with Tension Band Wiring: Kuen Tak Suh, Hyoung Lok Roh, Myung Soo Youn, Jung Sub Lee; J Korean Fract Soc 2006;19(4):424-430. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.424

Abstract

PURPOSE
To evaluate the results of internal fixation with bifurcate angled blade plate and tension band wiring of greater tuberosity or rotator cuff for the unstable proximal humerus fracture.
MATERIALS AND METHODS
Nineteen cases of unstable proximal humerus fracture who were followed up for more than 1 year were treated using bifurcate angled blade plate and tension band wiring between March 2003 and March 2005. Average age of the patients was 46.5 years (range, 24 to 69), and there were 9 male and 10 female patients. The radiological results were evaluated by bony union and neck shaft angle. In addition, the clinical results were evaluated by Neer's evaluation criteria.
RESULTS
In 18 out of 19 cases, bony union was obtained in average 12.5 weeks after operation. The neck shaft angles of sixteen cases were between 120 and 140 degrees by Paavolainen method. According to Neer's evaluation criteria, 17 cases showed excellent or good results.
CONCLUSION
The patients treated using bifurcate angled blade plate and tension band wiring could exercise earlier because of good initial stability. Also, the radiological and clinical results were relatively good. The treatment of unstable proximal humerus fracture with bifurcate angled blade plate and tension band wiring was considered as a good method.

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Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures
Chung Hee Oh, Joo Han Oh, Sae Hoon Kim, Ki Hyun Jo, Sung Woo Bin, Hyun Sik Gong
Journal of the Korean Fracture Society.2008; 21(3): 213. CrossRef

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The Treatment of Unstable Proximal Humerus Fracture Using Locking Plate: Eun Sun Moon, Myung Sun Kim, Kyung Soon Park, Jae Yoon Chung, Keun Bae Lee; J Korean Fract Soc 2006;19(2):193-200. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.193

Abstract

PURPOSE
The purpose of this study was to determine the results of internal fixation with locking plate system for the unstable proximal humerus fracture.
MATERIALS AND METHODS
Sixteen cases of unstable proximal humerus fracture were treated using locking plate system between September 2004 and June 2005. Average age of the patients was 55.6 years (range, 22 to 78), male was four patients, female was twelve. The clinical outcomes were evaluated by using Neer's evaluation criteria and Constant socring system. We analyzed the radiological results by bony union time and Paavolainen method. All data was analyzed statistically.
RESULTS
According to Neer's evaluation ciriteria, eleven cases (69%) showed excellent or satisfactory results and according to Constant scoring system, twelve cases (75%) showed excellent or good result. Twelve cases (75%) showed good results by Paavolainen method. In all cases, bony union was obtained in average 12.8 weeks after operation. There were two complications; one screw irritation and one screw loosing.
CONCLUSION
The patients treated using locking proximal humerus plate could exercise earlier due to good initial stability. And the clinical and radiological results were relatively good. The treatment of unstable proximal humerus fracture with locking plate system was considered as a good method.

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Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture
Jin-Oh Park, Jin-Young Park, Sung-Tae Lee, Hong-Keun Park
Journal of the Korean Fracture Society.2007; 20(1): 45. CrossRef

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Fixation Failure of LCP during the Treatment of Proximal Humerus Fractures: Woo Kie Min, Sang Jin Sin, In Ho Jeon, Ki Bong Cha, Chang Wuk Oh, Poong Taek Kim, Sang Ho Cheon; J Korean Fract Soc 2006;19(2):188-192. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.188

Abstract

PURPOSE
To evaluate the causative factors in the catastrophic failure of LCP in the proximal humerus fracture.
MATERIALS AND METHODS
Six patients (6 cases) were collected between October 2003 and July 2005. The mean age was 55.6 years (range: 38~70). The cause of injury was road traffic accident in four, fall down in one and slip down in one. According to the Neer classification, four were 2 part fractures, each one in 3 part fracture and 4 part fracture.
RESULTS
Fixation failure occurred due to back-out of the plate and screw in five and plate breakage in one. Analysis of the preoperative radiographs revealed medial cortical defect in all and no bone graft and tension band wiring in the greater tuberosity fragment were carried out. Postoperative radiographs showed the anatomical reduction in three and non-anatomical in three.
CONCLUSION
Non-anatomical reduction, insufficient medial bony buttress, inadequate screw length to the head and the neglect for the greater tuberosity fragment were the contributing factors to the failure of LCP. Knowledge of these factors will enable the surgeon to avoid failure of the LCP. Augmentation fixation and bone graft procedures with careful preoperative planning are necessary for successful fixation of LCP.

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The Result of Conservative Treatment of Proximal Humerus Fracture in Elderly Patients
Seung-Gil Baek, Chang-Wug Oh, Young-Soo Byun, Jong-Keon Oh, Joon-Woo Kim, Jong-Pil Yoon, Hyun-Joo Lee, Hyung-Sub Kim
Journal of the Korean Fracture Society.2013; 26(4): 292. CrossRef
A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus
Sung-Weon Jung
Journal of the Korean Fracture Society.2013; 26(1): 8. CrossRef
Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years
Ki Won Lee, Young Joon Choi, Hyung Sun Ahn, Chung Hwan Kim, Jae Kwang Hwang, Jeong Ho Kang, Han Ho Choo, Jun Seok Park, Tae Kyung Kim
Clinics in Shoulder and Elbow.2012; 15(1): 25. CrossRef
Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture
Jin-Oh Park, Jin-Young Park, Sung-Tae Lee, Hong-Keun Park
Journal of the Korean Fracture Society.2007; 20(1): 45. CrossRef

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Two-part and Three-part Fractures of the Proximal Humerus Treated with the Polarus Interlocking Nail: A Comparison of Fracture Types: Kyu Cheol Noh, Yung Khee Chung, Kook Jin Chung, Sung Ku Hong; J Korean Fract Soc 2006;19(2):182-187. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.182

Abstract

PURPOSE
To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types.
MATERIALS AND METHODS
There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (<50) results. Radiographic outcome measurements included fracture alignment (neck-shaft angle), loosening of screw, fixation and hardware failure, and malunion and nonunion.
RESULTS
Overall, the average ASES score was 80.2 (range 46.0 to 98.0). There were 15/22 (68.2%) excellent, 6/22 (27.3%) satisfactory, and 1/22 (4.5%) poor results. All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. When comparing patients with two-part fractures (n=11) with patients having three-part fractures (n=11), there were statistically significant differences with ASES outcome measures (p<0.05). But, there were no statistically significant differences in age-related analysis (p>0.05).
CONCLUSION
Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.

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Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis
Youn-Soo Hwang, Kwang-Yeol Kim, Hyung-Chun Kim, Su-Han Ahn, Dong-Eun Lee
Journal of the Korean Fracture Society.2013; 26(1): 14. CrossRef
Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus
Chul-Hyun Cho, Gu-Hee Jung, Kyo-Wook Kim
Journal of the Korean Fracture Society.2011; 24(3): 237. CrossRef

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Intrathoracic Migration of K-wire after Fixation of Proximal Huemrus Fracture: Case Report: Tae Jin Song, Joon Yeop Song, Sung Kon Kim, Jung Ho Park, Joon Ho Wang, Jong Woong Park; J Korean Fract Soc 2005;18(4):462-465. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.462

Abstract PDF

We report an unusual case of Kirschner wire migration from the proximal humerus into the thoracic cavity and diaphragm which induced pneumothorax and hemoperitoneum. An 81-year-old woman admitted to the emergency room due to sudden onset of dyspnea. X-rays showed pneumothorax and old proximal humerus fracture fixed with rush pins and K-wires. One of K-wires was seen on the diaphragm level at posterior gutter of chest wall. Through the abdomen, K-wire was removed from the diaphragm and a chest tube was inserted. The potential for K-wires to migrate must be recognized, and frequent postoperative radiographic studies have to be performed for the early detection of loosening and migration. It appears that if K-wires are used for fixation of proximal humerus, the lateral ends must be bent to prevent medial migration, and when the desired therapeutic goals have been achieved, these pins have to be susbsequently removed as soon as possible.

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Spinal Canal Migration of a K-Wire Used for Fixation of a Distal Clavicular Fracture
Byung-Ill Lee, Yong-Beom Kim, Hyung-Suk Choi, Chang-Hyun Kim, Jung-Woo Ji
Journal of the Korean Orthopaedic Association.2013; 48(3): 231. CrossRef
Early Intrathoracic Migration of K-wire Used for Fixation of Proximal Humerus Fracture
Sang Jin Cheon, Ji Min Lee
Journal of the Korean Orthopaedic Association.2011; 46(2): 167. CrossRef

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T-Plate Fixation for Two- and Three-Part Fractures of the Proximal Humerus: Dong Ju Shin, Se Ang Chang, Young Soo Byun, Dae Hee Hwang, Sung Rak Lee, Sang Hee Kim; J Korean Fract Soc 2005;18(4):426-431. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.426

Abstract PDF

PURPOSE
To evaluate the results and complications of treatment using T-plate fixation for two- and three-part fractures of the proximal humerus.
MATERIALS AND METHODS
Between January 1996 and July 2003, thirty-three patients with two-part and three-part fractures of the proximal humerus were treated by T-plate fixation. There were 21 two-part fractures and 12 three-part fractures including three shoulder dislocations. The reduction was qualified and complications were assessed with final radiographs. The functional outcome was evaluated by Neer's rating system.
RESULTS
Thirty-two cases (96.7%) were united, twenty-nine cases (87.9%) were reduced as good, and twenty-three cases (70%) had excellent or satisfactory results. There were four cases of loss of reduction, three cases of stiff joint, one case of nonunion, and one case of avascular necrosis of the humeral head, but no infection. No correlation was found between the final result and the type of fracture, age, gender, or quality of reduction.
CONCLUSION
T-plate fixation for proximal humeral fractures is a reliable method to obtain good results through satisfactory reduction, rigid fixation, and early movement. Additional tension band wiring can provide stable fixation for osteoporotic or comminuted fractures difficult to obtain stable fixation.

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The Surgical Outcomes for Isolated Greater Tuberosity Fracture of Proximal Humerus
Eun-Sun Moon, Myung-Sun Kim, Young-Jin Kim
Journal of the Korean Fracture Society.2007; 20(3): 239. CrossRef

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Inferior Subluxation of Humeral of Head after Surgery for Fracture of Proximal Humerus: Jun Gyu Moon, Hyok Woo Nam, Jong Oh Kim, Jong Kyoung Ha, Seok Bae Ryu; J Korean Fract Soc 2005;18(1):43-47. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.43

Abstract PDF

PURPOSE
To study the development of inferior shoulder subluxation after surgery for proximal humerus fractures. To analyze the mechanism development of such subluxation and the association between different types of proximal humerus fractures, quality of reduction achieved the method of operation performed.
MATERIALS AND METHODS
A retrospective analysis of 45 proximal humerus fractures that were treated by surgery between March 1997 and July 2002 was done. All patients had a minimum of 12 months of postoperative follow up. Preoperative radiographs were classified by the Neer's classification. Different operative treatment methods, post reduction alignment and the degree of postoperative subluxation if present, were analysed. In order to evaluate effect of loss of negative intraarticular pressure, we compared this series with 15 cases of recurrent shoulder dislocation treated by open Bankart operation.
RESULTS
13 patients out of 45 (29%) developed immediate postoperative inferior shoulder subluxation. 3-part fractures of the proximal humerus showed a higher incidence of the same than the 2-part types. The better reduced fractures had lesser rates of subluxation. Open reduction (39%, 11 patients) results in an increased incidence of inferior subluxation than closed methods of reduction (13%, 2 patients).
CONCLUSION
Inferior subluxation of the humeral head after surgery for the proximal humerus fracture can occur and persist till postoperative period of 2 months. Deltoid muscle tone affected by shortening of humeral neck plays an important role. Early active exercise for restoration deltoid tone may be effective in prevention of inferior subluxation.

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Transient postoperative inferior subluxation of the shoulder after surgical stabilization of recurrent anterior dislocation in a patient with myasthenia gravis: a case report
Samuel Baek, Geum-Ho Lee, Myung Ho Shin, Tae Min Kim, Kyung-Soo Oh, Seok Won Chung
Clinics in Shoulder and Elbow.2023; 26(3): 302. CrossRef

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Closed Reduction and External Fixation of Displaced Fractures of the Proximal Humerus: Seung Ju Jeon, Ho Seung Jeon, Kye Nam Cho, Jae Ho Choi, Joon Yong Lee; J Korean Fract Soc 2004;17(1):43-48. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.43

Abstract PDF: PURPOSE
This is a retrospective study to analyze the functional results of closed reduction and external fixation of unstable fractures of the proximal humerus.
MATERIALS AND METHODS
Ten unstable proximal humerus fractures were managed with closed reduction and external fixation in which other operative methods are not proper due to comminution, osteoporosis or poor general condition of patients. 4 cases of 2-part and 6 cases of 3-part fracture were included. Radiologically union of fracture, malunion and the evdence of avascular necrosis of humeral head were assessed and the functional results were analyzed with Neer scoring system.
RESULTS
Radiologically all fractures were healed but in 2 cases malunion was resulted because of reduction loss in proximal fragment. Pin site infection was developed in 7 cases and oral antibiotics were needed. The functional results were excellent in 4, satisfactory in 3 and unsatisfactory in 3 cases. 2 cases with malunion and one case with lack of postoperative cooperation resulted in functionally unsatisfactory.
CONCLUSION
External fixation is an alternative method in the treatment of unstable proximal humerus fractures in which open reduction or percutaneous pinning are not proper due to comminution, osteoporosis or poor general condition of patient.

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Closed percutaneous K-wire stabilization for fractures of the proximal humerus: Dong Wha Lee, Kyoo Seok Shin, Jei Bum Kim; J Korean Soc Fract 2002;15(4):566-572. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.566

Abstract PDF: PURPOSE
The purpose of this study is to analyze the result and complications of treatment using percutaneous K-wire stabilization for fractures of the proximal humerus. MATERIALS & METHOD: To be eligible for the study, total 12 patients of displaced two, three or four part fractures of the proximal humerus were treated, 10 females and 2 males with a mean age of 52 years (range 18-76 year). Reduction was obtained by longitudinal traction combined with posterior pressure on the humeral shaft. After reduction, minimum two 2.5mm terminal threaded pin or smooth tip K-wire was inserted.
RESULTS
Union rate of 83.3% was observed at an average 2.7 months. Range of motion of shoulder was 125 degrees of forward flexion, 114 degrees of abduction. Patients of 83.3% had good or excellent functional result. Four patients had a mild, superficial pin tract infection associated with loosening of the pin. The infections resolved with removal of pin and oral antibiotics. Valgus deformity was developed in a patient however the patient subsequently had a good functional result and nonunion were developed in two cases.
CONCLUSION
The technique of closed reduction and percutaneous pinning is quite demanding procedure, although it may appear to be deceptively simples. The good indications for the use of this procedure seems to patients with severe comminuted fractures, old age with osteoporosis. For the more rigid fixation, terminally threaded pins should be used, not smooth pin.

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Comparison study between valgus and varus type in Neer 's 3 and 4 part proximal humerus fracture: Chang Hyuk Choi, Koing Woo Kwon, Shin Kun Kim, Sang Wook Lee, Dong Kyu Shin, Seung Jin Lee; J Korean Soc Fract 2002;15(4):558-565. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.558

Abstract PDF: PURPOSE
We reclassified three- and four-part proximal humerus fractures by Neer ' s classification into valgus & varus type, and compared the results of these groups. MATERIALS & METHODS: 21 cases classified as three- and four-part fracture in Neer 's classification were treated surgically and followed for 12 months. We reclassfied the 21cases valgus and varus type fractures, according to angulation of fractures, facing of humeral head, and dominant displaced tuberosity. Functional evaluation was done by UCLA shoulder rating scale.
RESULTS
Neer 's three- and four-part proximal humerus fractures could be reclassified based on angulation, facing of humeral head, and dominant tuberosity displacement. The functional results according to UCLA shoulder rating scale were good or excellant in 8 of 9 cases of valgus type(89%), and at 4 in 10 cases of varus type(40%). The clinical result of the valgus type was better than that of the varus type.
CONCLUSION
Based on reclassification system of proximal humerus fractures, clinical results and radiographic findings including angulation, facing of head, and dominant tuberosity displacement showed close relationship. Neurovascular complication were more frequent in the varus type. Therefore, careful evaluation including surgical approach and soft tissue status should be considered in the varus type of complex proximal humerus fracture.

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Interlocking Intramedullary Nailing of the Proximal Humerus Fracture in Elderly Patients over 65 Years old: Hee Gon Park; J Korean Soc Fract 2002;15(3):385-390. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.385

Abstract PDF: PURPOSE
The purpose of this study is to document the result of the interlocking intramedullary nailing of the proximal humerus fracture in eldery patients over 65 years old.
MATERIALS AND METHODS
We performed a clinical and radiographic assessment after a follow up period exceeding 12months of 14cases of interlocking intramedullary nailing of proximal humerus fracture.
RESULTS
By Kronberg 's radiogrphic evaluation, 9 cases were good, 4 cases were acceptable, 1 case was poor. The average pain index was 3.2 point by Howkins guide line. All patients complained about final range of motion, especially in abduction and flexion movement.
CONCLUSION
Though the interlocking intramedullary nailing was an attractive alternative for the proximal humerus fracture stabilization for early rehabilitation in eldery patients over 65 years old, but should be consideration for postoperative shouder pain and loss of motion

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External Fixation of Displaced Proximal Humeral Fracture: Suk Kyu Choo, Byung Jik Kim, Jin Hwan Kim, Seung Yeub Suk, In Hwan Hwang; J Korean Soc Fract 2002;15(3):379-384. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.379

Abstract PDF: PURPOSE
Proximal humerus fractures are relatively frequent and have variable treatment mothods. It is important to resolve union of the fracture site, good range of motion and function through the early ambulation in treatment results. We will know whether it is recommendable treatment or not and analyze the results of treatment on the effectiveness of the external fixator in two or three part fractures of the proximal humerus fractures.
MATERIALS AND METHODS
From May, 1999 to April, 2001, 8 cases in 8 patients were treated by external fixator on the proximal humerus fractures. Mean age was 44.7yrs(11 to 68 yrs), two part fracture 6 cases, three part fracture 2 cases in fracture classification by Neer. We treated 3 cases with ring external fixator, 4 cases with monoplane external fixator. We referred chart and radiographics to patients and assessed the results by Neer 's shoulder function table through final follow-up or phone call.
RESULTS
In all cases, we obtained bone union without neuroparalysis, neurovascular injury, avascular necrosis and other complications. Mean bone-union time was 7 weeks(5 to 12 weeks). Final functional assessments are excellent or good in 7 cases, poor in 1 case.
CONCLUSION
We obtained comfortable results after we performed external fixation on proximal humerus fracture and bone union was acquired and removed external fixator at 7 weeks through early ambulation. We think procedure has brief, low soft tissue damage, high stability and motily. Thus we think it is recommendable treatment on the displaced proximal humerus fractures.

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The Result of Treatment in Fracture of the Proximal Humerus: Man Je Park, Byeong Yeun Seong, Seung Ki Lee, Taek Gun Lee, Sang Yol Shin, Hyung Su Kim; J Korean Soc Fract 2002;15(2):299-306. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.299

Abstract PDF

PURPOSE
To evalute the anatomical and functional outcome after treatment for proximal humerus fracture according to surgical and conservative treatment and assess the final results according to treatment methods.
MATERIALS AND METHODS
Forty-two cases with follow-up over 12 months were divided into three groups: conservative treatment (Group 1, 20 cases), closed reduction with Rush or percutaneous pin fixation (Group 2, 11 cases), proximal intramedullary interlocking nailing(Group 3, 11 cases). The functional outcome was obtained by modified neer method using self-assessed score paper and the anatomical outcome was obtained by paavolainen method using radiologic film score. Statistics in comparing with the result of each group was analized by variance analysis using Generalized Liner Model and Fisher?s exact test.
RESULT
Anatomical reduction was best obtained in group 3 (p< 0.05) and mean duration of bone union was 10.33 weeks. Functional score was also best obtained in group 3 (p<0.05). Complication was noted in 9 cases. There was only 1 case in group 3. In studing of overall outcome, the group 3 has good result than other groups.
CONCLUSION
Proximal intramedullary interlocking nailing in displaced proximal humerus fracture can be demonstrated as better method for anatomical reduction(p<0.05) than other methods because it can make insertion of locking screw ease with multiple direction for anatomical reduction and can provides a sufficient fixation for early rehabilitation and union , while minimizing complication.

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Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?
Woo-Bin Jung, Eun-Sun Moon, Sung-Kyu Kim, David Kovacevic, Myung-Sun Kim
BMC Musculoskeletal Disorders.2013;[Epub] CrossRef
Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture
Doo-Sup Kim, Dong-Kyu Lee, Chang-Ho Yi, Jang-Hee Park, Jung-Ho Rah
Journal of the Korean Fracture Society.2011; 24(2): 144. CrossRef

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Closed Reduction and Percutaneous Fixation in the Treatment of Proximal Humerus Fractures: Seung Ju Jeon, Hyung Ku Yoon, Ho Seung Jeon, Kye Nam Cho, Hyung Sam Kim; J Korean Soc Fract 2002;15(2):173-180. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.173

Abstract PDF: PURPOSE
This is a retrospective study to analyze the functional results of closed reduction and percutaneous fixation of displaced unstable proximal humerus fractures.
MATERIALS AND METHODS
We report 23 patients, 20 with 2-part and 3 with 3-part proximal humerus fractures that can be reduced closed but remain unstable in which percutaneous fixation was performed. The fixation methods were multiple pinning in 10, multiple cannulated screw fixation in 8, Rush pin fixation in 3 and Rush pin combined with other methods in 2. The functional rusults were analyzed with Neer,scriteria.
RESULTS
The functional rusults were excellent in 14, satisfactory in 4 and unsatisfactory in 5. No significant difference was not noted in the long term follow-up results according to the fixation methods but Rush pin resulted in impingement and displacement of greater tuberosity.
CONCLUSION
Closed reduction and percutaneous fixation is a useful alternative to open reduction and internal fixation for the displaced 2-part or 3-part proximal humerus fractures that can be reduced closed but remain unstable.

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Treatment of the Two part or Three part Fracture of Proximal Humerus: Jin Rok Oh, Doo Hee Lee, In Gu Kim; J Korean Soc Fract 2000;13(4):960-969. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.960

Abstract PDF: PURPOSE
The current study is performed to evaluate the clinical outcomes of treatment for two part or three part fractures of proximal humerus. MATERIAL AND METHODS: Forty-five cases that followed up over 6 months were divided into three groups : conservative treatment(Group I, 16 cases), closed reduction with internal fixation(Group II, K-wire 10, schanz pin 4, cancellous screw 3, 17 cases) and plate and screw fixation(Group III, 12 cases). The range of motion, pain index with self assessed functional score, anatomical reduction and bone union period and complications were examined.
RESULTS
The range of motion was worst in group I, and anatomical reduction was best in group III. The functional score of group II(average 80), group III(average 73) were higher than group I, but there were no significant differences between group II and group III. Complications were noted in 17 cases, which occured mostly in group I and III. Avascular necrosis of humerus head was noted in one case of group II. Bone union period was average 10.4 weeks.
CONCLUSION
If anatomical reduction could be obtained by closed reduction and internal fixation with K-wire, schanz pin and cancellous screw in 2 part or 3 part proximal humerus fracture, it would provide a sufficient fixation for early rehabilitation and bone union, while minimizing complications.

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Comparative study between operative and conservative treatment in 3 part and 4 part fracture of the proximal humerus: Chang Hyuk Choi, Kwoing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Dong Kyu Shin, Bum Jin Park; J Korean Soc Fract 2000;13(2):390-396. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.390

Abstract PDF: PURPOSE
: Majority of 3-part and 4-part fracture of proximal humerus had been treated by surgical methods. However, Surgical treatment might be inappropriate due to the medical status or combined injures if the patients. Therefore, we compared the operative treatment with the conservative treatment in 3-part and 4-part fracture of proximal humerus.
MATERIALS AND METHODS
: Among the 39 cases of 3-part(30) and 4-part(9) fracture of proximal humerus, 22 cases(57%) were treated by conservative methods and 17 cases(43%) were treated by operative methods with T-plate, wire, arthroplasty and screw.
RESULTS
: Among 30 cases of 3-part fracture of proximal humerus, according to the Neer's functional criteria, 12cases(60%) had excellent or satisfactory result in conservative treatment and 7cases(70%) had excellent or satisfactory result in operative treatment. In 9 cases of 4-part fracture of proximal humerus, 2 cases(100%) had poor result in conservative treatment, and 5 cases(71%)had excellent or satisfactory result in operative treatment.
CONCLUSION
: There was no difference in functional result according to the treatment modality in 2-part fracture(p>0.05). but in 4-part fracture, we prefer to treat by operative methods due to avascular necrosis at humeral head and poor functional result with conservative treatment.

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Treatment of Two-part, Displaced Surgical Neck Fracture of the Proximal Humerus with Modified Ender Nail and Tension Band Technique: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):395-401. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.395

Abstract PDF

Operative treatment of two-part, displaced surgical neck fractures of the proximal humerus is used when satisfactory closed reduction cannot be achieved or maintained. Recently, we modified the Ender nails by making an additional hole above the slot for wire incorporation. The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing and tension band technique. We reviewed the data of fourteen consecutive patients (10 women and 4 men) who had been treated with Ender nailing and tension band wiring between from Aug 1996 and Oct 1997 at Eulji Medical College Hospital. The average age of patients was 54 years (range, 38 to 79 years), and the average follow-up period was 18 months (range, 12 to 24 months). Bone union was observed at 6.3 weeks (range, 5.5 to 10 weeks), except one case of delayed union. There were no infections and nonunions. The average ranges of shoulder elevation and abduction were 140 degrees(100 degrees to 170 degrees) and 126 degrees(100 degrees to 160 degrees), respectively. The median value of the thumb to vertebral distance was L1, with a range of T6 to L5 for internal rotation, external rotation was 48 degrees (30 degrees to 70 degrees) . Radiography revealed one case of medial shift greater than 5mm, and 4 cases of lateral shift greater than 5mm of the humeral shaft. The average varus angulation of the humeral neck was 8.5o(0 degree to 34 degrees). Four patients (28.6%) were excellent (34 to 35), six patients (42.8%) were good (28 to 33), four patients (28.6%) were fair (21 to 27) in UCLA shoulder rating scale. In conclusion, Ender nailing and incorporation of the tension band wire loops provided additionally rotational and longitudinal stability in two-part displaced surgical neck fracture of the proximal humerus associated with osteoporosis.

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Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis
Soo-Tai Chung, Joo-Hak Kim, Hyung-Soo Kim, Sang-Joon Park
Journal of the Korean Fracture Society.2007; 20(2): 184. CrossRef

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Treatment of Surgical Neck Fracture and Fracture Dislocation in Proximal Humerus: Sung Ill Baek, Eea Sub Chung; J Korean Soc Fract 1997;10(4):897-903. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.897

Abstract PDF: The management of the two part surgical neck fracture, three part fracture and fracture-dislocation of proximal humerus is still under debate. Various method of internal fixation have been reported but none of these methods have been consistently successful. The purpose of this study is to analyze the result of open reduction and internal fixation surgical neck fracture, three-part fracture and fracture-dislocation in proximal humerus. From Janunary. 1991 to July 1996, fifteen patiens were reviewed and the result were summerized as follows. 1. There were 8 two-part surgical neck fracture, 3 three-part fracture, 4 three-part fracture-dislocalion. 2. The results were analyzed accroding to scoring system of Neer; the excellent or satis-factory results were seen in 11 cases, but unsatisfactory results were seen in 4 cases. 3. Complication occured as follows; joint disability in 4 cases, high positioning of plate in 1 case of joint disability. 4. We concluded that T-plate offers satisfpctory reduction and good stability at high risk of joint disability. Early mobilization is required in the prevenion of joint disability of shoulder.

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Proximal Humeral Fracture with Epiphyseal Plate Injury: Sung Kwan Hwang, Jin Rok Oh, Jung Ho Rah, Ki Ho Kim; J Korean Soc Fract 1997;10(4):793-800. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.793

Abstract PDF: Proximal humerus fracture with epiphyseal plate injury does not cause the growth disturbances and deformity of humerus in comparison with other fracture of epjphyseal plate. The explanation about this phenomenon is that the fracture occurs microscopically in maturing Bone near provisional calcifying zone, another explanation is that the epiphyseal plate in proximal humerus greatly contribute the longitudinal growth of humerus and has trimendous remodelling potential. In this study, we experienced the 25 cases of proximal humeral epiphyseal injury from January, 1991 to June, 1997 We analyzed the growth disturbance and deformity of the proximal humeral epiphyseal plate in regard to age, fracture type, treatment method of the 15 cases with 3 years follow-up among the 25 cases. This fracture is most common in the age of 13 to 16, 11 cases among total 15 cases(75 percent). Most common fracture type is type II by Salter-Harris classification, 14 cases among total 15 cases, 3 cases is type IV by Neer-Horowitz classification, where, manual reduction was impossible because of interposition with biceps tendon between fracture fragments. There was no impairment of motion, growth distrubance and deformity in all cases. We concluded there is no direct correlation with patient age, the degree of fracture, displacement, treatment method in view of gorwth disurbance and deformity.

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Hemiarthroplasty for Treatment of Proximal Humerus Fracture: Chung Nam Kang, Jong Oh Kim, Sang Hun Ko, Young Do Koh; J Korean Soc Fract 1997;10(3):685-693. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.685

Abstract PDF: From 1993 to 1996, we have used hemiarthroplasty on shoulder for comminuted fracture and fracture-dislocation of proximal humerus. The study reviewed 8 patients with on average age 62.1 years. The hemiarthroplasty was performed at average 5 days following injury. The purpose of this study was to evaluate pain, function, range of motion, strength, patients satisfaction. All cases was performed using cement and surgical approach was deltopectoral. Average follow up was 33 months after operation(range, 24 to 45 months). According to UCLA shoulder rating scale, 5 patients(63%) were satisfactory and 3 patients(37%) were unsatisfactory. Average active flexion was 110, and average abduction was 97 and average external rotation was 39, average internal rotation to the first lumbar vertabrae. Average humeral offset on fractured shoulder was 20.5 and average humeral offset on normal uninjured shoulder was 30.8. For functional improvement of shoulder hemiarthroplasty, We concluded humeral length restoration and humeral offset preservation is very crucial factors.

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Treatment of the Proximal Humeral Fracture by Bent Semitubular Plate: Choong Gil Lee, Jin Woo Kwon, Jae Hyum Park, Sung Ho Shin, Wan Eub Kim; J Korean Soc Fract 1997;10(3):634-639. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.634

Abstract PDF: There is no consensus on the best way to treat complicated fractures of the proximal humerus. Open reduction and internal fixation with plate is one of the most popular method, but it has several disadvantages. Thus we used bent semitubular plates to fix the proximal humeral fractures, which were reported by Szabo and Sehr. Moda etc. This method provided relatively firm fixation and then early ROM exercise was possible even in case of osteoporotic or severely comminuted fractures. We treated 9 cases of proximal humerus fractures which were with bent semitubular plates from January 1992 to June 1996 and followed up more than 6 months. The following results were obtained. 1. The bent semitubular piate fixation was useful method even in treatment of comminuted or osteoporotic proximal humerus fractures. 2. The mean duration of radiologic bone union was postoperative 10 weeks. 3, Complications developed in 2 cases ; one case was plate failure and the other was humeral head penetration by blade portion. 4, According to Neer criteria 5 cases were excellent, 2 cases satisfactory, 1 case unsatisfactory and 1 case failure.

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A Operative treatment of the three-part, four-part Fracture and Fracture dislocation in proximal humerus: Young Su Lee, Min Ki Kim; J Korean Soc Fract 1997;10(1):112-118. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.112

Abstract PDF: The three part, four part fracture and fracture-dislocation of proximal humerus generally need operative treatment but treatment of these fractures has remained controversal. The purpose of this study is to analyze the result of operative treatment of three-part, four-part fracture and fracture dislocation in proximal humerus. From Jan 1990 to July 1995, Eleven patiens were reviewed and the result were summerized as follows. 1. There were 4 three-part fracture, 1 four-part fracture, 4 three-part fracture-dislocation, 1 head-spliting fracture, 1 impression fracture. 2. Open reduction and internal fixation was done in 7 cases, prothetic replacement was done in 4 cases. 3. The result were analyzed accroding to scoring system of Neer. 1) The excellent or satisfactory result were seen in 5 cases of three part fracture and fracture-dislocation, but in none case of four-part fracture. 2) The excellent or satisfactory result were seen in 3 cases with open reduction and internal fixation, and in 3 cases with prothetic replacement. 4. Among the cases with joint disability(5), there are 1 three-part fracture-dislocation, 1 head-spliting, 2 three-part fracture, 1 four-part fracture. 5. The rigid fixation and early mobilization is considered to be a good modality.

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