Journal of Musculoskeletal Trauma

Cannulated Screw Fixation for 4 Part Fractures of the Neck of Humerus: Ho Jung Kang, Doo Hyung Lee, Hong Kee Yoon, Soo Bong Hahn; J Korean Fract Soc 2005;18(4):432-436. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.432

PURPOSE
To analyze radiological and functional results after open reduction and internal fixation for fractures of the neck of humerus (4-part) using cannulated screws. MATERIAL AND METHODS: Between January 1997 and April 2004, 11 patients with neck of humerus fracture (4-part) were treated operatively by open reduction and internal fixation with cannulated screws. Two surgical approaches (deltopectoral for 9 cases and deltoid splitting for 2 cases) were used. The mean age was 36 years old and the mean duration of follow-up was 56 months. ASES (American Shoulder and Elbow Surgeons) score was checked to evaluate the function in shoulder joint. We used 2 cannulated screws in 2 cases, 3~4 screws in 6 cases and over 5 screws in 3 cases for fixation. In 2 cases, K-wires were used additionally and autoiliac bone graft was done in 1 cases which had poor bone mass.
RESULTS
All cases got bony union at 5.6 months on average. In functional assessment of shoulder, eight patients got excellent, one got good points. There were complications including shoulder stiffness in 2 cases, avascular necrosis of humeral head in 1 case and subacromial impingement syndrome in 1 case.
CONCLUSION
Internal fixation using cannulated screws for fractures of humerus neck (4 part) showed good bony union and functional results in patients under 50 years old who had average bone quality.

Citations

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The Surgical Outcomes for Isolated Greater Tuberosity Fracture of Proximal Humerus
Eun-Sun Moon, Myung-Sun Kim, Young-Jin Kim
Journal of the Korean Fracture Society.2007; 20(3): 239. CrossRef

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Comparative study between operative and conservative treatment in 3 part and 4 part fracture of the proximal humerus: Chang Hyuk Choi, Kwoing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Dong Kyu Shin, Bum Jin Park; J Korean Soc Fract 2000;13(2):390-396. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.390

Abstract PDF: PURPOSE
: Majority of 3-part and 4-part fracture of proximal humerus had been treated by surgical methods. However, Surgical treatment might be inappropriate due to the medical status or combined injures if the patients. Therefore, we compared the operative treatment with the conservative treatment in 3-part and 4-part fracture of proximal humerus.
MATERIALS AND METHODS
: Among the 39 cases of 3-part(30) and 4-part(9) fracture of proximal humerus, 22 cases(57%) were treated by conservative methods and 17 cases(43%) were treated by operative methods with T-plate, wire, arthroplasty and screw.
RESULTS
: Among 30 cases of 3-part fracture of proximal humerus, according to the Neer's functional criteria, 12cases(60%) had excellent or satisfactory result in conservative treatment and 7cases(70%) had excellent or satisfactory result in operative treatment. In 9 cases of 4-part fracture of proximal humerus, 2 cases(100%) had poor result in conservative treatment, and 5 cases(71%)had excellent or satisfactory result in operative treatment.
CONCLUSION
: There was no difference in functional result according to the treatment modality in 2-part fracture(p>0.05). but in 4-part fracture, we prefer to treat by operative methods due to avascular necrosis at humeral head and poor functional result with conservative treatment.

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A Operative treatment of the three-part, four-part Fracture and Fracture dislocation in proximal humerus: Young Su Lee, Min Ki Kim; J Korean Soc Fract 1997;10(1):112-118. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.112

Abstract PDF: The three part, four part fracture and fracture-dislocation of proximal humerus generally need operative treatment but treatment of these fractures has remained controversal. The purpose of this study is to analyze the result of operative treatment of three-part, four-part fracture and fracture dislocation in proximal humerus. From Jan 1990 to July 1995, Eleven patiens were reviewed and the result were summerized as follows. 1. There were 4 three-part fracture, 1 four-part fracture, 4 three-part fracture-dislocation, 1 head-spliting fracture, 1 impression fracture. 2. Open reduction and internal fixation was done in 7 cases, prothetic replacement was done in 4 cases. 3. The result were analyzed accroding to scoring system of Neer. 1) The excellent or satisfactory result were seen in 5 cases of three part fracture and fracture-dislocation, but in none case of four-part fracture. 2) The excellent or satisfactory result were seen in 3 cases with open reduction and internal fixation, and in 3 cases with prothetic replacement. 4. Among the cases with joint disability(5), there are 1 three-part fracture-dislocation, 1 head-spliting, 2 three-part fracture, 1 four-part fracture. 5. The rigid fixation and early mobilization is considered to be a good modality.

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