Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus

Heilmann, Lukas F.; Katthagen, J. Christoph; Raschke, Michael J.; Schliemann, Benedikt; Lill, Helmut; El Bajjati, Hassan; Jensen, Gunnar; Dey Hazra, Rony-Orijit

Abstract

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n= 11), while most surgical neck fractures were treated with locked plating (n= 6). Patients with impression type fractures showed significantly better ASES scores (p= 0.041), Simple Shoulder Test scores (p= 0.003), Rowe scores (p= 0.013) and WOSI scores (p= 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.