The three-part fracture of the proximal part of the humerus. Operative treatment

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Hawkins RJ. Bell RH. Gurr K. x Journal of Bone & Joint Surgery - American Volume. 68(9):1410-4, 1986 Dec. x A retrospective review of the cases of fifteen patients with a three-part x fracture of the proximal part of the humerus is presented. Fourteen of the x fractures were treated with tension-band wiring and one, with an AO x buttress plate. The patients were evaluated for pain, range of motion, x strength, and function of the involved shoulder and the radiographic x result at an average of fifty-four months after the injury. At follow-up, x the shoulders had an average of 126 degrees of active elevation, 29 x degrees of active external rotation, 81 degrees of active abduction, and x internal rotation to the second lumbar vertebra. The only early x complication was failure of fixation in the patient who had been treated x with a buttress plate. In two patients, radiographic evidence of avascular x necrosis of the humeral head later developed, and one of them required x revision to a hemiarthroplasty. In conclusion, we recommend operative x treatment for the healthy, active individual who has a three-part fracture x of the proximal part of the humerus. We found that the best results with x these difficult fractures are obtained using tension-band wiring. x