Resumo

JOSE GUALA, Agustín; RANALLETTA, Maximiliano  e  MAIGNON, Gastón D.. Treatment of complex fractures of the proximal humerus. Locking plate vs. Hemiarthroplasty: Mid-term results. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2009, vol.74, n.3, pp.258-263. ISSN 1852-7434.

Background: The treatment of complex fractures of the proximal humerus is challenging. Because of high risk of avascular necrosis (AVN) with conventional plates, hemiarthroplasty has been the treatment of choice. Locking plates for proximal humerus seems to be a good alternative for these fractures but information of outcomes lacks. The objective of this research is to prospectively evaluate mid term outcomes of complex fractures of the proximal humerus treated with hemiartroplasty or open reduction and internal fixation (ORIF) with locking plates. Methods: Between January 2003 and January 2007, 44 complex proximal humeral fractures were treated surgically and followed up for a minimum of 12 months. Twenty-two were treated with locking plates and 22 with hemiartroplasty. At follow up patients were evaluated with UCLA, Quick DASH and modified Constant Score. Mobility, pain and quality of life were also evaluated with the use of visual analogue scales (VAS). Results: Mean follow up was similar in both groups (24 months in plates and 27 in hemiarthroplasty). Clinical outcomes were better in the group treated with locking plates with statistically significance in Constant Score, UCLA, and Quick DASH. Function and mobility were also better for plates group. Pain and quality of life were similar for both groups. Union was observed in all cases treated with ORIF but there were 2 AVN of the humeral head with bad results. Conclusions: In our series better outcomes were obtained in the group treated with locking plates. These differences are related with a better range of motion and strength in this group. The counterpart of this treatment is the risk of AVN and bad results related to it.

Palavras-chave : Proximal humerus fracture; Internal fixation; Hemiarthroplasty.

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