Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus

Abstract

Aim
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different 
time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were 
analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All 
patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and 
statistical methods were used for analysis.
Results
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly 
better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 
10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 
mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring 
normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also 
demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). 
Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a 
fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is 
diagnosed.
Conclusion
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current 
approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.