Transitory percutaneous pinning in fractures of the proximal humerus

doi:10.1016/S1058-2746(99)90091-5

Journal of Shoulder and Elbow Surgery

Volume 8, Issue 6, November–December 1999, Pages 569-573

https://doi.org/10.1016/S1058-2746(99)90091-5 Get rights and content

Abstract

We report 31 patients with displaced fractures of the proximal humerus treated by transitory percutaneous pinning. The Neer fracture classification was used; there were 7 two-part, 20 three-part, and 4 four-part fractures. The Constant score was used for evaluation of the results; the mean score was 80 points. The high mean age of our patients (68 years) diminished the score because of the 25 points attributed to the strength. Avascular necrosis was observed in 5 cases: 2 threepart and 3 four-part fractures. Transitory percutaneous pinning is a good technique for the management of displaced 3-part fractures of the proximal humerus even in the older population, keeping in mind that the shoulder will tolerate a moderate residual deformity without changing the functional outcome significantly. Transitory percutaneous pinning, on the other hand, is not a satisfactory method for the management of 4-part fractures.

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Cited by (45)

Fractures of the Proximal Humerus
2016, Rockwood and Matsen’s The Shoulder
Proximal humerus fractures: Percutaneous fixation, proximal humeral nailing, and open reduction and internal fixation
2015, Shoulder and Elbow Trauma and its Complications: The Shoulder: Volume 1
Fractures of the proximal humerus occasionally require operative fixation. Three options exist currently to treat these fractures: open reduction and internal fixation (ORIF), percutaneous fixation (PF), and proximal humeral nailing (PHN). ORIF has enjoyed recent popularity, but recent studies report a high incidence of complications, especially in the elderly patient. PHN is advantageous for two-part and some three-part fractures. PF is also an option in elderly patients with two- and three-part fractures. Surgical decision making can be complex and depends on a number of factors, including age, bone quality, surgeon skill level, medical comorbidities, and patient compliance. In general, further research is needed to determine the ideal surgical technique.
Results of percutaneous treatment of proximal humeral fractures in patients of working age
2011, Revista Espanola de Cirugia Ortopedica y Traumatologia
Valorar los resultados obtenidos con el tratamiento percutáneo o mínimamente invasivo de las fracturas desplazadas de húmero proximal en una serie de pacientes en edad laboral y buena calidad ósea.
El estudio retrospectivo incluye 90 sujetos tratados en nuestro hospital. Las fracturas se distribuyeron según la clasificación de Neer en 21 fracturas en 2 partes, 44 en 3 partes y 25 en 4 partes. En 5 sujetos hubo luxación asociada. Las fracturas en 3 y 4 partes lo fueron impactadas en valgo y algún caso en varo. Todos los casos se resolvieron mediante cirugía percutánea o mínimamente invasiva, por manipulación de los fragmentos y estabilización con agujas de Kirschner y/o tornillos canulados.
La valoración se realizó mediante el test de Constant con un resultado promedio de 77. Sufrieron complicaciones 15 pacientes (17%), siendo la más frecuente la necrosis avascular con 4 pacientes (4%).
Creemos que en sujetos jóvenes y en edad laboral el tratamiento percutáneo de estas fracturas constituye un método de tratamiento fiable, consiguiéndose en nuestra serie un 92% de reincorporaciones laborales y con escasas complicaciones.
To evaluate the results obtained with percutaneous or minimally invasive treatment of displaced fractures of the proximal humerus in a series of patients of working age and with good bone quality.
The retrospective study included 90 subjects treated in our hospital. The fractures were distributed, according to the Neer classification, into 21 fractures in 2 parts, 44 in 3 parts, and 25 in 4 parts. Five of the subjects had an associated joint dislocation. The fractures in 2 and 3 parts were impacted in valgus and some were in varus. All the cases were resolved with percutaneous or minimally invasive surgery by manipulation of the fragments and stabilising with Kirschner wires and/or cannulated screws.
The evaluation was performed using the Constant test, with a mean result of 77. A total of 15 (17%) patients suffered complications, the most frequent being avascular necrosis in 4 patients (4%).
We believe that percutaneous treatment of these fractures young subjects of working age is a reliable treatment method, achieving a 92% return to work in our series and with few complications.
Hemiarthroplasty for Four-Part Fractures of the Proximal Humerus
2011, Operative Techniques in Orthopaedics
Hemiarthroplasty is a time-tested and valuable tool in a surgeon's armamentarium for the treatment of complex fractures of the proximal humerus. Hemiarthroplasty has been shown to reliably relieve pain; functional outcomes are less predictable. Hemiarthroplasty is demanding, and meticulous attention to detail is required for a successful outcome. Reconstruction of proximal humeral anatomy via the restoration of humeral height, version, and alignment is the foundation of the operation. However, tuberosity repair is arguably the most important part of the procedure. Tuberosity malposition and malunion is the most common and significant cause of poor functional outcomes. This article reviews the technique of hemiarthroplasty for fractures of the proximal humerus.
The impacted varus (A2.2) proximal humeral fracture in elderly patients: Is minimal fixation justified? A case control study
2009, Journal of Shoulder and Elbow Surgery
The purpose of this retrospective case control study was to assess the outcome of K-wire osteosynthesis of a varus displaced proximal humeral fracture in patients over 65 years old, compared to a control group treated nonoperatively.
The patient cohort was taken from our database in the period 2003-2007. After data extraction, the patients were re-examined and scored by the Constant score (CS), modified Constant score (MCS), and the QuickDASH score. The control group was carefully selected and matched to the surgical one for age, type of fracture, and degree of displacement. Minimum follow-up was 12 months, with a mean of 30 months in the surgery group, and 27 months in the nonoperative group.
K-wire osteosynthesis in our series yielded consistently good results in older patients who sustained an A2.2 proximal humeral facture, with an average MCS of 88 points and a QuickDASH score of 15. The surgery group had a statistically significant higher CS and modified Constant score at follow-up than did the conservatively treated group (p = .03).
Operative treatment of varus displaced proximal humerus fractures treated with K-wire osteosynthesis yields good results that are superior to those treated nonoperatively.
Level 3; Case control study, treatment study.
Proximal humeral fractures: A systematic review of treatment modalities
2008, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
Those treated with HHR had substantially lower values of forward flexion and abduction. Fourteen of the 15 papers that reported on outcomes following treatment of 3- or 4-part fractures were considered level 4 evidence1,17,19,21,23,28,31,38,39,52,60,62,64,83 while the remaining paper was level 3 evidence.81 Three- and 4-part fractures have been treated by percutaneous methods with K wires and additional cannulated screws, with the subcutaneous K wires being removed after 4 weeks64.
A systematic review was conducted of primary intervention of proximal humeral fracture, which is a common injury with significant morbidity. Keywords of proximal humeral fracture were entered into PubMed and Embase databases. Two evaluators reviewed abstracts from 1985 to 2004 for inclusion and exclusion criteria yielding 66 articles. These articles were evaluated independently for outcomes and quality of evidence using the Structured Effectiveness Quality Evaluation Scale and Sackett's Levels of Evidence. Patient characteristics and outcomes were recorded. The 66 studies included 2155 patients grouped by fracture types according to the Neer classification system. Studies differed by intervention, methods, outcome measures and results. Quality scores averaged 15/48; only 2 articles included randomized groups. Current studies typically lack randomization, comparators, and independent evaluation, with a resultant inability to produce clinical conclusions. Further research comparing primary treatment methods in a properly designed and controlled fashion is required, ideally using randomized controlled trials.

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Original articleTransitory percutaneous pinning in fractures of the proximal humerus

Abstract

J Shoulder Elbow Surg

Orthop Clin North Am

J Shoulder Elbow Surg

Fractures of the proximal humerus

Résultats des prothèses d'épaule pour fractures

Comminuted fractures of the proximal humerus

Clin Orthop

A clinical method of functional assessment of the shoulder

Clin Orthop

The arterial vascularization of the humeral head

J Bone Joint Surg Am

Internal fixation techniques for proximal humeral fractures

Clin Orthop

Epidemiology of fracture of the upper end of the humerus

Clin Orthop

Original article
Transitory percutaneous pinning in fractures of the proximal humerus