Indicazioni al trattamento chirurgico delle fratture metaepifisarie prossimali di omero

Fractures of the proximal humerus are frequent injuries which include a wide spectrum of anatomo-clinical situations with different therapeutical problems. In recent decades the refinement of internal fixation techniques and humeral head prosthetic replacement has markedly improved the prognosis of the more severe fractures. In this study we have retrospectively reviewed the results achieved in 82 patients with proximal humeral fractures; 38 patients of this series underwent surgical treatment. The fractures were identified according to Neer's four-segment classification. Undisplaced fractures were uniformly treated by simple immobilization, while the management of displaced fractures consisted of different conservative or surgical options. The average follow-up was 43.6 months (range, 18 to 76 months). According to Constant's rating scale, better clinical results were observed in less severe injuries, although a good shoulder function was observed also in complex fractures treated surgically. Surgical treatment of proximal humeral fractures is indicated in case of instability or subacromial displacement of the fragments, in three- or four-part fractures, in fractures-dislocations and in fractures complicated by neurovascular injurt. However, an adequate rehabilitation program is necessary for the successful outcome of treatment.