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.