Explosive Fractures of the Upper End of the Humerus1

FRACTURES of the upper end of the humerus usually leave a certain amount of permanent disability. The typical result is limited abduction and restricted external rotation, which impairs any function of the arm above the horizontal plane. There are several causes for this disability, the chief of which is incomplete anatomical reduction. Complete reduction is difficult because the small upper fragment is uncontrollable both as to alignment and rotation. A functional result requires that the shaft be brought into alignment with this uncontrollable fragment, and that both fragments be returned to their normal positions around the long axis. This ideal of anatomical reduction has been stressed greatly since the war and has completely changed the treatment of fractures in this region. A second feature of equal weight has not been emphasized in the recent literature. We believe that it is a determining element in the final disability and that it is one of the most important factors in handling these fractures. ...