Closed reduction and external fixation for displaced proximal humeral fractures

Abstract

Purpose: To assess results of closed reduction and external fixation for displaced proximal humeral fractures.

Methods: 18 men and 2 women aged 18 to 60 (mean, 38) years underwent closed reduction and external fixation using a standard AO fixator for displaced fractures of the proximal humerus. Injury mechanisms were road traffic accident (n=15) and fall from a height (n=5). 15 were 2-part fractures of the surgical neck, 4 were 3-part fractures of the greater tuberosity and surgical neck, and one was a 4-part fracture. One patient also had a grade-1 open fracture. The quality of reduction and shoulder function were assessed.

Results: The mean duration of external fixation was 38 (range, 29-46) days. The mean time to radiological union was 11 (range, 9-13) weeks. The mean follow-up period was 11 (range, 6-18) months. Reduction was good (position equivalent to minimal displacement) in 12 patients and fair (good bony contact between the fragments) in 8 patients. Seven patients had pin site infection; all responded to local dressings and oral antibiotics. No patient had avascular necrosis of the humeral head. The mean Neer score was 85 (range, 42-98) out of 100. Shoulder function was excellent in 10 patients, satisfactory in 6, unsatisfactory in 2, and a failure in 2.

Conclusion: External fixation preserves the vascularity of the fracture fragments, enables early mobilisation, and achieves safe healing and good function. It is effective for management of displaced proximal humeral fractures.