抄録
With the aim to clarify the prognostic factors that may affect the treatment results of proximal humeral fractures, we retrospectively analyzed a total of 687 cases registered to the JSS database. In this study, the active elevation of the shoulder was used as an indicator of the functional outcome, with 150 degrees or over as being excellent, 90 to 150 degrees as being fair, and less than 90 degrees as being poor. Of the 183 one-part fractures, 24 (13 percent) showed a poor result. Particularly, 18 (20 percent) of the 88 cases that had a fracture line in the surgical neck proved to be poor. The risk factors for the poor outcome included the age of the patients, comorbidity such as dementia, and a varus deformity at the surgical neck (neck-shaft angle < 120 degrees). Of the 126 two-part surgical neck fractures, 21 (17 percent) showed a poor result, with the age, comorbidity, and varus deformity as being risk factors. Of the 47 two-part greater tuberosity fractures, only 2 (4 percent ) showed a poor result. Of the 73 three- and four-part fractures, 22 (30 percent) showed a poor result, with age and persisting displacement of tuberosities as being risk factors. Hemiarthroplasty had been performed in 21 three- and four-part fractures, of which 19 (90 percent ) resulted in a poor outcome. We would like to emphasize that varus deformity of the surgical neck and the poor reduction or redisplacement of the tuberosities should be avoided to obtain better functional results in treating proximal humeral fractures.
