Results of surgical treatment of neer 4-part fracture-dislocations of proximal humerus

Abstract

Purpose: to analyze results of ORIF surgical treatment of Neer 4-part fracture-dislocation of proximal humerus (FDPH). Material and methods: in period 2013-2015,in IEM's Orthopedics Department were treated 11 patients with Neer 4-part FDPH, injury's nature being specified by Rx and CT-scan. All patients underwent ORIF, in 6 cases with T-plate and 5 cases- Philos plate, at 9-40 hours after trauma. Gender distribution: 6 women and 5 men, with age limits: 28 and 67 years. Right thoracic limb was fractured in 7 cases, left – 4 cases. All dislocations were anterior. Patients were monitored 6-18 months. Deltoido-pectoral approach was performed in 8 cases and transcoracoid - 3 cases, being used in marked displacement of humeral head to prevent neuro-vascular complications. Long bicipital tendon was used as anatomical landmark between greater and lesser tubercle, which were fixed to plate with non-absorbable threads. Diaphysis was impacted in order to obtain primary stability. Functional outcomes were assessed using Constant score and analog pain scale. Results: at 6-8 months was determined 120° flexion angle (in 90-135° diapason), average abduction angle – 100° (in 70-140° diapason). Average Constant score was 72 points (in 60-85 diapason). Mild pain was determined in 7 cases, moderate – 4 cases. In 8 cases fracture was at surgical neck's level, in 3 cases – anatomical neck's level. In 1 case was detected transient axillary nerve injury, screw's migration from humeral head – 1 case, humeral head's AN – 5 cases and vicious consolidation – 3 cases. Conclusions: 1. Successful treatment of given injury is provided by anatomic reduction and stable fixation, with maximum maintaining of fragments blood supply. 2. Humeral head's AN doesn't exclude good functional outcome, unlike fragments vicious consolidation. 3. Transcoracoidal approach allows avoiding of severe neuro-vascular complications, ensures convenient fragments reposition and fixation.