Results of the percutaneous pinning of proximal humerus fractures with a modified palm tree technique

Abstract

Purpose: Many techniques are available for closed reduction and percutaneous fixation of proximal humeral fractures. The palm tree technique was described by Kapandji in 1989. In that technique three curved wires are inserted through one hole at the V-shaped insertion of the deltoid muscle. It is a good technique but it has some disadvantages. In this study we introduced some modifications for the technique, and we evaluated the clinical results of the modified technique in treatment of 18 cases.

Methods: Eighteen patients with displaced proximal humeral fractures were treated by closed reduction and percutaneous fixation with the palm tree technique after minor modifications. The age of the patients ranged from 38 to 75 years with an average of 56 years. Eleven were females and seven were males. The fractures were two-part in 13 cases and three-part fractures in five cases.

Results: The average time of healing was seven weeks. The follow-up period ranged from 14 months to 39 months with an average of 22 months. The Constant score ranged from 45 to 88 with a mean of 73. The results were satisfactory in 77% and unsatisfactory in 23% of the cases. The complications included pin tract infection in two cases, intraarticular wire migration in one case, skin necrosis around the wires in three cases and malunion with varus deformity in one case. No cases were complicated by neurovascular injury, loss of fixation or avascular necrosis of the humeral head.

Conclusions: The palm tree technique is a good method for fixation of proximal humeral fractures. It produces good grip in both of the proximal and distal fragments and allows for early joint movements. Our modifications allow for easy insertion of the wires, increase the stability of fixation and minimize the risk of complications.

Fig. 1

a The sharp end of the wire is cut and the first 5 mm of the wire is bent by about 45 degrees followed by a smooth gentle curve over the next 10 cm of the wire. b Two drill holes are made in the lateral and anterolateral cortices of the distal fragment using a 2.5-mm drill bit directed obliquely from distal to proximal. c Two wires are inserted in the predrilled holes and advanced till the fracture site. d Reduction is adjusted and the wires are advanced into the subchondral bone of the proximal fragment. e A third wire is added to increase the stability of fixation

Fig. 2

a A 53-year-old female patient with displaced proximal humeral fracture. b Closed reduction and fixation with the modified palm tree technique. c After healing of the fracture and removal of the wires