Long term results of percutaneous fixation of proximal humerus fractures

Abstract

Background: Proximal humerus fracture in elderly osteoporotic patients usually leads to severe displaced and multifragmentary fractures. Associated comorbidities may limit surgical options and conservative treatment is commonly indicated, however, with variable results. In most cases, surgery is the treatment of choice in order to restore anatomical integrity, and allow early functional recovery. Several techniques were used over the years, each with specific indication. Percutaneous pinning after closed reduction, a mini-invasive technique and fixation by use of K-wires is not preferred commonly. We present our experience with this approach, focusing on its indications and advantages.

Patients and methods: A study group of 41 consecutive patients with a mean age of 65.5 years were evaluated clinically (VAS, Constant-Murley score, range of motion), and with radiological analysis: 35 patients finally completed a minimum followup of 24 months.

Results: K-wires were removed after a mean interval of 4 weeks. Clinical and radiographic healing occurred in a mean time of 8.2 weeks in all fractures but one, with improvements in mean Constant-Murley score of 87.6 points, mean VAS of 2.3. In 33 patients, the reduction was considered satisfactory. In two cases, reduction was poor, but the patients however presented acceptable functional outcome.

Conclusions: Percutaneous pinning may represent a suitable option of treatment for 2-or 3-part proximal humerus fractures in selected subjects.

Keywords: Percutaneous fixation; percutaneous pinning; proximal humerus fractures.

Figure 1

X-ray (anteroposterior view) left proximal humerus in a 61-year-old man showing (a) 3 part proximal humerus fracture; (b) postoperative X-rays with well alligned fragments and k-wires in situ; (c) X-rays at 5 years followup with well healed and remodeled proximal humerus

Figure 2

X-ray (anteroposterior view) left proximal humerus in a 36-year-old woman showing (a) 2-part proximal humerus fracture; (b) postoperative X-rays with adequate reduction of the fragments and k-wires in situ; (c) X-rays and CT scan at 8 years followup with loss of reduction and atrophic nonunion patient was asymptomatic