[Surgical treatment of proximal humerus XXXX --international multicenter study].

@entity1 @entity73 @entity174
To receive an overview of the presently used methods for the operative treatment of @entity174 of the proximal humerus a prospective controlled multicenter study was arranged. 146 @entity174 from 145 @entity1 (76 females, 69 @entity1 ) were assessed, documented with the AO standard sheets and radiographs and with a one year follow-up examination. Each of the nine clinics used his own treatment scheme. They applied: K-wires (27%) for adaptation and for intramedullary fixation; tension band wires (16%) or sutures (11%) alone or in combination with K-wires; osteosynthesis with screws alone (7%) or with plates (22%). In 17% the humeral-head was acutely replaced with a prosthesis. 11 @entity174 (8%) had to be reoperated because of instability or loss of fixation. 109 @entity1 were available for clinical review, one @entity1 could be questioned by letter and six @entity1 had died after one year (follow-up 80%). In 38% of @entity1 full limb function was restored, @entity73 persisted in 45% and 17% remained severely handicapped. 96 @entity174 (89%) were consolidated, 30% with a deformity. 35% of @entity1 still were unable to work full time. The treatment of @entity174 of the proximal humerus is generally difficult. More over the various operative methods and problematic fracture classification make a differentiate statistical analysis impossible. Still many questions remain. For answers a new trial is mandatory. For this future series fixed guidelines for indications and operative treatment modalities are required to allow a meaningful comparison of results and a scoring system for evaluation of functional outcome is necessary.
