• Carlos Martin, Melchor Guillen, and Gonzalo Lopez.
• Department of Orthopaedic Surgery, Obispo Polanco Hospital, Teruel, Spain. cmartin@cmedico.e.telefonica.net
• Acta Orthop. 2006 Apr 1; 77 (2): 275-8.

BackgroundTreatment of fractures of the humeral head remains controversial. We reviewed the outcome of our treatment of 2- and 3-part fractures of the proximal humerus using external fixation as a way of preventing damage to the vascularity of the humeral head and of reducing the risk of infection associated with open techniques.MethodWe retrospectively evaluated 2- and 3-part fractures of the humeral head, both clinically and radiographically, in 62 consecutive patients who were treated using external fixation. The mean follow-up time was 1.5 (1-2) years.ResultsThe reduction was considered to be good in 50 cases, and 8 cases were consolidated in varus and 4 cases in valgus. The fracture healed in all patients. Except for 1 case of superficial infection around the screws and 1 redisplacement after a new fall, there were no early complications. Necrosis of the humeral head was not observed. 2 of the patients underwent shoulder replacement because of severe pain. The mean Constant score was 84 points, with satisfactory results (>or=80 points) in 49 of the 62 patients. Sex, age, side, or type of fracture had no influence on the outcome.InterpretationThis procedure provides satisfactory early functional results, simplifies rehabilitation by limiting postoperative motion to a lesser degree than other techniques, is less aggressive than open reduction techniques and osteosynthesis, and leads to few complications.

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