A scientific exhibit (S 15) on operative repair of four-part fractures of the proximal humerus, shows excellent long-term clinical results have been achieved by early prosthetic replacement of the head and repair of the tuberosities and rotator cuff.
The study found that physiologic restoration of shoulder function is possible using correct placement of prosthetic components, with functional cuff and healed tuberosities resulting in most cases.
According to this study of 70 surgical cases, the technique of four-part proximal humerus fracture repair is dependent on exact fracture pattern, quality of bone fragments, tissue quality, and soft tissue injury.
Repair begins with identification of bony and soft tissue landmarks. The biceps groove and tendon, when intact, are important in judging prosthetic height and version. Tuberosity fragments must be mobilized as anatomically as possible to allow bony healing and restoration of muscle tendon length and motion.
Repair is carried out by preliminarily using distal biceps groove and tendon as landmarks, and tuberosities are repaired to the bone and prosthesis using nonabsorbable sutures passed through drill holes. This approach allows early rehabilitation without weakening the repair. The humeral head is often used to bone graft the shaft and facilitate tuberosity healing.
Early passive range of motion exercises are critical in obtaining an excellent result postoperatively. Braces and splints are rarely used.
The limits of physical therapy are determined intraoperatively, based on the quality of tissue and repair. Results are based on fracture patterns and patients' compliance with therapy.
At follow-up (average 2-7 years), 95 percent of patients achieved significant pain relief; 89 percent were able to satisfactorily perform their activities of daily living.
In overall results, 53 patients (82 percent) were rated as excellent or satisfactory, according to Neer's criteria.
Co-authors of the study are Louis U. Bigliani, MD, professor of orthopaedic surgery, College of Physicians and Surgeons, Columbia University and chief of shoulder service, vice chairman, department of orthopaedic surgery, New York Orthopaedic Hospital; and Kenneth Yamaguchi, MD, assistant professor of orthopaedic surgery, the shoulder and elbow service, department of orthopaedic surgery, Washington University Medical School, St. Louis. Also, all of New York Orthopaedic Hospital, Patrick M. Connor, MD, shoulder fellow; William N. Levine, MD, shoulder fellow; Roger G. Pollock, MD, assistant professor of orthopaedic surgery; Evan L. Flatow, MD, associate professor of orthopaedic surgery; and Edward B. Self Jr. MD, assistant clinical professor.
||1996 Academy News Index|
Last modified 27/September/1996