Purpose: To evaluate the clinical results of open reduction and internal fixation (ORIF) in proximal humerus fractures with delayed presentation.
Design: Retrospective comparative study.
Setting: Level III.
Methods: From June 2005 to June 2010, thirty-nine (39) proximal humerus fractures were treated with ORIF after a delay of 21-120 days from the initial injury. Patients were divided into three groups: (1) isolated 2-part greater tuberosity fractures; (2) part surgical neck fractures; and (3) 3- and 4-part complex fractures. The range of motion (ROM), visual analogue scale (VAS), Constant-Murley score, University of California Los Angeles (UCLA) scoring system score and Simple Shoulder Test (SST) score were all recorded. The results were analyzed with the use of the Mann-Whitney U test and stratified by age, gender, side of injury, interval from injury to surgery, and postoperative functional results. Additionally, the results of different fracture types and complications were compared across the three groups.
Results: The mean forward flexion was 143.8°±28.9°, external rotation was 33.2°±19.6°, and internal rotation was up to the T10 level. The mean VAS was 0.8±1.2; the mean Constant score was 82.0±15.0; the UCLA score was 27.2±7.1; and the mean SST was 9.5±2.0 at the last follow-up. There were no significant differences among the three groups except in internal rotation. Compared to those without any complications, patients with complications demonstrated worse ROM and a lower functional score (p<0.05).
Conclusions: Delayed treatment of proximal humerus fractures is a challenging problem. With appropriate surgical technique, satisfactory results can be expected with respect to different fracture types, and complications may be avoided regardless of delay.
Level of evidence: Therapeutic Level IV.