[Purpose] We have performed surgical treatment for the proximal end of humeral fractures in severe joint displacement and instability. In this report, we aim to study about the factors of poor prognosis of these fractures from the surgical results at our hospitals.
[Subjects] During the past 10 years, surgical treatment was performed on 13 cases with a fracture in the proximal end of the humerus: 6 men and 7 women.9 cases had a fracture in the left arm, and the other 3 cases had a fracture in the right arm. Their age ranged from 15 to 82 years (average: 55.9years), and the duration of postoperative follow-up ranged from 8 months to 4 years and 10 months (average: 2 years ). According to Neer's classification system,6 cases were type III,3 cases were 3part in type IV,1 case was 4-part in type IV, and 2 cases were 4-part in type IV.
[Results] Surgical osteosynthesis was performed on 9 cases, and endoprosthesis was performed on 4cases. The postoperative results were assessed by the JOA score. The JOA score of the 13 cases ranged from 69 to 98 points (average: 83.1 points), and a factor that reduced the JOA score the most was the range of motion, followed by pain.
[Discussion] In particular, the range of motion was limited and pain was confirmed in cases with a fracture of type IV or VI in which the greater tubercle displacement persisted and rotator cuff function was reduced. These findings suggest that the prevention of elevated greater tubercle and the reconstruction or maintenance of rotator cuff function are important in surgically repairing fractures in the proximal end of the humerus.
