1: J Bone Joint Surg Am. 2003 Sep;85-A(9):1647-55.  

Severely impacted valgus proximal humeral fractures. Results of operative
treatment.

Robinson CM, Page RS.

Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh, Scotland.
c.mike.robinson@ed.ac.uk

BACKGROUND: The functional results associated with nonoperative treatment of
severely impacted valgus fractures of the proximal part of the humerus are poor,
and these injuries are difficult to treat with minimally invasive percutaneous
fixation techniques. The aim of this study was to review the functional and
radiographic results and complications of a new operative technique in a series
of twenty-five patients. METHODS: Over a two-year period, we treated twenty-nine
patients with a severely impacted valgus fracture of the proximal part of the
humerus. Three patients were lost to follow-up and one died, leaving twenty-five
patients who were available for the study. In all of the fractures, the
head-shaft angle had been tilted into > or = 160 degrees of valgus and the
greater tuberosity was displaced by >1 cm. All patients were treated with open
reduction of the fracture, and the space created behind the humeral head was
filled with Norian Skeletal Repair System (SRS) bone substitute. The fractures
were stabilized with either screws or buttress plate fixation. Associated
rotator cuff tears were repaired. All patients underwent functional outcome
assessment with use of the Constant, DASH (Disabilities of the Arm, Shoulder and
Hand), and SF-36 (Short Form-36) scores at one year, and twelve patients were
followed for two years. RESULTS: All fractures united within the first year, all
reductions were maintained, and no patient had signs of osteonecrosis of the
humeral head on the latest follow-up radiographs. At one year, the median
Constant score was 80 points and the median DASH score was 22 points. The
functional results continued to be satisfactory in the twelve patients who were
followed for two years. The results in our series were better than those
achieved in studies of nonoperative treatment of similar fracture
configurations. There were six clinically relevant complications, although none
required a reoperation and all six patients had a satisfactory short-term
functional outcome. CONCLUSIONS: Internal fixation of severely impacted valgus
fractures of the proximal part of the humerus, supplemented by Norian SRS bone
substitute to fill the proximal humeral metaphyseal defect, produces good early
functional and radiographic outcomes. Additional follow-up will be required to
assess whether these initially satisfactory outcomes are maintained over the
longer term.

PMID: 12954821 [PubMed - indexed for MEDLINE]