• S Greiner, M J Kääb, N P Haas, and H J Bail.
• Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Stefan.greiner@charite.de
• Injury. 2009 Feb 1;40(2):186-91.

IntroductionShort-term follow-up of angular stable fixation for proximal humeral fractures has been well documented in the literature. Longer follow-up series are difficult to find. However, especially regarding the risk of avascular humeral head necrosis longer follow-up series are high of clinical relevance.MethodsForty-eight patients with a mean age of 66 years and treated with open reduction and angular stable internal fixation for proximal humeral fractures were followed up for a mean of 45 months. The clinical and radiographic follow-up (Constant Score (CS), age and gender related Constant Score (agCS), Constant Score in comparison to the contralateral side (%CS) and shoulder anterior-posterior and lateral view and axial view X-rays) was performed postoperatively.ResultsClinical results after 45 months showed a mean CS of 66.2+/-15.4 points with a mean agCS of 90.0+/-23.1%. Evaluation of the %CS showed 77.7+/-17.8%. %CS results showed no significant differences after 45 months in comparison to those obtained after 12 months. However, incidence of avascular necrosis of the humeral head doubled over the follow-up period from 4 cases at 12 months follow-up to 9 cases at final follow-up.ConclusionResults of open reduction and internal fixation with angular stable implants for proximal humeral fractures are reliable, however long-term complications such as avascular necrosis of the humeral head need to be evaluated further on since its incidence increases over the time.

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