Proximal humeral fractures. Ipsilateral associated injuries of the upper extremities and shoulder girdle

Question. The aim of this study was to elucidate associated injuries of the upper extremities and shoulder girdle in proximal humeral fractures and to evaluate their impact on clinical outcome. Methodology. Between January 2001 and March 2008 a total of 641 patients where operated due to proximal humeral fractures. All patients were retrospectively analyzed in terms of associated injuries and 58 patients (9 %) with associated injuries on the ipsilateral upper extremity were identified, of whom 36 (mean age 67 years, 24 women, 12 men) could be clinical examined (DASH and Constant scores) after a mean follow-up of 38 months. Results. The 58 patients with associated injuries where treated with plate osteosynthesis (38 patients), nail osteosynthesis (7 patients) and primary shoulder prosthesis in 12 patients. One patient received a screw osteosynthesis. Most associated injuries were distal radial fractures and nerve injuries. Appearance of distal radial fractures was linked to low-energy trauma, whereas high-energy trauma was related to elbow injuries, especially elbow dislocation. Proximal humeral fractures with glenohumeral dislocation were associated with a higher risk of nerve injury. Associated injuries occurred more often in women and mostly in patients aged 60 years and older. Men with associated injuries were distributed over the whole life span. Evaluation of 36 patients in follow-up revealed a mean DASH score of 35 points and a mean Constant score of 56 points. Osteosynthesis of proximal humeral fractures led to better results than primary arthroplasty. Conclusion. The combination of proximal humeral fracture and ipsilateral associated injury is common and related to osteoporotic bone. Treatment includes osteosynthesis of all fracture sites to allow fast mobilization. Functional results are dependent on type of treatment of proximal humeral fractures. This trial might help clinicians to identify a risk population for those injuries in respect to patient age, sex and energy of trauma.