Percutaneous elastic fixation of proximal humeral fractures: operative indications, techniques, results and complications

Abstract

IntroductionFractures of the proximal humerus represent 4%-5% of all fractures. Although they can occur anytime after birth, their incidence increases progressively with age, particularly in women, because of postmenopausal osteoporosis, so that about 80% of affected people older than 50 years are women [1].The most used classification of these fractures was developed by Neer [2] in 1970 ( Fig. 1), starting from Codman's classification, based on the four constitutive fragments of the proximal humerus (head, tuberosities and diaphysis). Neer integrated it with notions of biomechanics, i.e. the analysis of muscular forces displacing fracture, and of physiopathology, i.e. the evaluation of possible vascular deficits of the humeral head (Fig. 2) [3] following trauma. Therefore, this classification allows one to determine the prognosis of the fracture, the risk of necrosis of the humeral head and the expectation of functional recovery of the shoulder, and consequently to choose among conservative treatment, osteosynthesis and prosthetic replacement. More complex, and therefore less used, is the AO/ASIF classification (Fig. 3) [4].In 85% of cases, the fractures are composed, so that they can be treated conservatively with simple immobilization [5]. In the remaining 15%, there is indication to the surgical treatment but, as it is known, there are controversies both on which classification to use (Neer versus AO/ASIF), because neither is entirely reliable [6], and on which surgical technique to choose, because neither is effective in all cases, either for technical difficulties or for insufficient functional results.We report the short-term results of the elastic osteosynthesis with percutaneous threads, a method that differs from the traditional static assemblage because it causes compression and not only an alignment at the focus of fracture.

Valgus impacted proximal humeral fractures and their blood supply after transosseous suturing

“…Many operative techniques and fixation methods have been used to treat displaced proximal humeral fractures [2,4,6,8,9,11,13,14,16,19,20,21]. Current trends in surgical technique for four-part "valgus impacted" fractures include limiting soft tissue dissection around the fracture fragments, reduction of the head to its anatomical position, and minimally invasive osteosynthesis [10,12,[17][18][19]22].…”

Management of unstable comminuted proximal humerus fractures with percutaneous pinning: A prospective study

“…The results of the current study are comparable with the results of Fenichel et al [11] using threaded pins for two-part fractures as they achieved an average Constant score of 86 points (range 78-100 points) and also for the range of motion. Rosa et al [12] reported a Constant score between 33 and 84 points using two elastic smooth pins inserted through the head at the level of the physis. The common complications reported in the literature are pin site infection, stiffness, loss of fixation, axillary nerve injury, secondary displacement, and deep infection [13][14][15] .…”

“…Rosa et al [12] reported a Constant score between 33 and 84 points using two elastic smooth pins inserted through the head at the level of the physis. The common complications reported in the literature are pin site infection, stiffness, loss of fixation, axillary nerve injury, secondary displacement, and deep infection [13][14][15] . In the present study, We had total 3 complications include 1 pin site infection; 5 post traumatic stiffness & 1 case of avascular necrosis.…”

Functional results of shoulders Neer’s prosthesis for four part fracture dislocation of shoulder

“…Surgical options include different fixation techniques (percutaneous pinning, intramedullary nailing, plating) as well as shoulder arthroplasty. 6 The choice of procedure should be made considering several local( fracture pattern, quality of bone, status of rotator cuff) and general (comorbidities, functional demands, compliance to treatment) factors. Unfortunately, insufficient straightforward recommendations and significant variation in clinical practice among orthopaedic surgeons indicates a lack of consensus regarding optimal treatment of these fractures.…”