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Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury). <\/jats:p><jats:p> Following treatment by open reduction and internal fixation, only two of 23 patients with type-I injuries developed radiological evidence of osteonecrosis of the humeral head, compared with four of seven patients with type-II injuries. <\/jats:p><jats:p> A policy of primary treatment by open reduction and internal fixation of type-I injuries is justified, whereas most elderly patients (aged 60 years or over) with type-II injuries are best treated by hemiarthroplasty. The best treatment for younger patients (aged under 60 years) who sustain type-II injuries is controversial and an individualised approach to their management is advocated. <\/jats:p>","DOI":"10.1302\/0301-620x.88b4.17195","type":"journal-article","created":{"date-parts":[[2006,3,27]],"date-time":"2006-03-27T22:49:31Z","timestamp":1143499771000},"page":"502-508","source":"Crossref","is-referenced-by-count":73,"title":["Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation"],"prefix":"10.1302","volume":"88-B","author":[{"given":"C. M.","family":"Robinson","sequence":"first","affiliation":[{"name":"The Shoulder Injury Clinic, The Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SU, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. A. 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