Management of Neer’s four-part fracture-dislocations of the proximal humerus using tension band wiring and cancellous screws

Abstract Background: To evaluate functional results of management of Neer’s four-part fracture-dislocation of proximal humerus by open reduction and internal fixation using screws and tension band wiring (TBW) technique. Settings and Design: This prospective study was performed in the Orthopedic Department of our rural area-based Medical College Hospital. Materials and Methods: Twenty-two patients presented with Neer’s four-part fracture-dislocation: four patients opted for hemiarthroplasty at higher centers, one patient was treated conservatively, and 17 patients were treated by open reduction and internal fixation using 6.5 mm two cancellous screws, and our TBW technique were analyzed for this study. The average age of patients was 49.94 years (35 to 70 years) which included eight males and nine females. The fracture pattern was anterior fracture-dislocation in 13 patients and posterior fracture-dislocation in four patients. One patient had bilateral four-part anterior fracture-dislocation. All patients were assessed at follow-up using the constant score and radiographic anterior–posterior and axial views performed postoperatively and at follow-up. Follow-up range was 1 to 20 years. Statistical analysis used: Descriptive Analysis. Results: Fractures united in all patients except one. Six patients had excellent results, six patients had good results, four patients had fair results, and one patient had poor results. Avascular necrosis was seen in four patients, re-dislocation was seen in one patient, shoulder impingement was seen in one patient, and one patient developed a superficial infection. Conclusions: Open reduction and internal fixation using tension band technique achieve fracture union in anatomical position with satisfactory functional results in spite of complications such as avascular necrosis and re-dislocations. Level of Evidence: IV; therapeutic study, case series.