Features of Safe and Efficient Treatment Approaches for New Proximal Humeral Fracture-Dislocations

AimThe study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within differenttime frames for optimizing treatment tactics.Patients and MethodsThis retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients wereanalyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. Allpatients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological andstatistical methods were used for analysis.ResultsAssessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantlybetter results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoringnormal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was alsodemonstrated 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 afracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head isdiagnosed.ConclusionThe present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Currentapproaches for endoprosthesis replacement in these cases remain debatable and require further investigation.