Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Abstract

Purpose Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general condition. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. We evaluated the results of percutaneous fixation of three-or four-part fractures of the proximal humerus of patients in the American Society of Anesthesiologists physical status three or four treated either with MIROS or traditional percutaneous pinning (TPP). Methods A total of 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Pre-operatively anteroposterior and transthoracic or axillary radiographs were obtained in all cases and computed tomography scans in patients with the most complex fractures. Follow-up evaluations were carried out at three, six, 12 and 16 weeks, and six months, one year and two years postoperatively, using the Constant Score (CS) and subjective shoulder value (SSV) methods.Results Of the 58 patients, 52 could be evaluated at all follow-ups. In both three-or four-part fractures there were significantly higher CS and SSV scores in the MIROS compared to the TPP group at all the late follow-ups. Lower rates of deep infection, pin tract infection and pin mobilisation were found in the MIROS group (p<0.001). In both groups there was a significant association between the final result (CS) and either the type of fracture or complications (p<0.001). Conclusions The MIROS resulted in better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general condition.

Evaluation of functional outcomes of a modified technique for percutaneous pinning of proximal humeus fracture

“…Patient characteristics and injury mechanisms in our study were similar to previous studies; more commonly being an elderly female sustaining trauma to shoulder following a trivial fall [11][12][13][14] . In our study, the mean time to radiological union was 2 months, which is comparable to previous studies on use of external fixator in proximal humerus [15,16] . There was only one incidence of pin migration and in none of the cases there was pin loosening inspite of early mobilization.…”

Midterm outcome and complications after minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock

“…Carbone et al reported 2-year outcomes after traditional percutaneous pinning (TPP) and a special technique of percutaneous pinning (called MIROS 1 ) similar to an external fixator in elderly patients and poor general health conditions (American Society of Anaesthesiologists (ASA) stage 3 or 4) for three-and four-part fractures [45]. The CS for three-part fractures was 53 points in the TPP group and 62 points in the MIROS 1 group, whereas for four-part fractures it was 50 points and 58 points, respectively.…”

Incidence and Severity of Infections After Closed Reduction and External Fixation of Proximal Humeral Fractures

“…Previous reports on proximal humerus fractures treated with external fixation found a 6%-19% infection rate. [15][16][17] The 39.1% infection rate in the current study is based on clinical diagnosis with only partial confirmation through positive cultures. These liberal criteria may be responsible for the high rate compared with previous reports.…”