The fracture-dislocation of the proximal humerus is uncommon desease and is associated with great therapeutic problems. The purpose of this study is to report the incidences and the results of it's treatments.
From 1980 to 1990, 36 patients had consulted our hospitals with displaced 2 part (18 pts.), 3 part (6 pts.), 4 part (9 pts.) and articular surface (3 pts.). 29 patients were followed up from one to eleven years with an average of 5.3 years after the treatment and evaluated in accordance with the criteria proposed by the Japan Orthopaedic Association (JOA score).
The average age at injury of females (40.6 years) was statistically higher than that of males (64.7 years). The patients with 2 part were commonly found between 40 and 70 years old. The patients with 4 part or articular surface were found below 40 years or above 60 years old. These specific incidence of the fractured type were thought that this fracture-dislocation was produced by the injury force and the strength of patient's bone mineral content. Eleven patients with 2 part treated coservatively had 97 points of average JOA score and four patients treated operatively had 85 points. The patients with 3 part treated conservatively had good score than that with 3 and 4 part and articular surface which were treated operatively. Also avascular necrosis of the head was observed in patients with 3 and 4 part treated operatively and the score were 69 and 75 points respectively. In four patients, the humeral heads were resected and the average score was 52 points.
These results suggest that the conservative treatment is recommended for the patients with 2 part and the prostretic replacement is indicated for the patients with 4 part.
