Two-part and three-part fractures of the proximal humerus treated with suture fixation

J Orthop Trauma. 2003 May;17(5):319-25. doi: 10.1097/00005131-200305000-00001.

Abstract

Objective: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with nonabsorbable rotator cuff-incorporating sutures.

Design: Retrospective.

Setting: University hospital.

Patients: There were 27 patients (28 shoulders) with displaced proximal humerus fractures. There were 13 greater tuberosity (GT) and 9 surgical neck (SN) two-part fractures and 6 GT/SN three-part fractures. The average age was 64 years (range 38 to 84 years). The average follow-up was 4.4 years (range 1.0 to 11.5 years).

Intervention: All patients were surgically treated solely with heavy polyester nonabsorbable sutures.

Main outcome measurements: Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score and Neer's criteria, which grade outcomes as excellent, satisfactory, or unsatisfactory.

Results: Overall, there were 22 (78%) excellent, 3 (11%) satisfactory, and 3 (11%) unsatisfactory results, and the average ASES score was 87.1 (range 35.0 to 100.0). All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. Twenty-four shoulders (86%) had anatomic alignment on postoperative radiographs. Of four shoulders with nonanatomic alignment, three had ASES scores of >/=90, with excellent Neer scores. When comparing patients with isolated two-part GT fractures (n = 13) with patients having two-part SN or three-part SN/GT fractures (n = 15), there were no statistically significant differences with respect to range of motion (P > 0.05) and outcome measures (P > 0.05). All patients who had unsatisfactory outcomes were noncompliant with physical therapy, with ASES scores averaging 39.4 (range 35.0 to 43.3).

Conclusion: Two-part and three-part GT and SN fractures can be treated satisfactorily with heavy nonabsorbable rotator cuff-incorporating sutures, particularly in elderly patients. Hardware-associated complications are obviated. Patients with SN fractures treated with sutures can have outcomes similar to patients with two-part GT fractures. Although the goal is to reconstruct a "one-part" fracture pattern, some residual deformity does not preclude an excellent outcome. A compliant patient is crucial for a successful result.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fracture Fixation, Internal / methods*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Shoulder Fractures / surgery*
  • Sutures*