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Percutaneous Fixation: When and How

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Simple and Complex Fractures of the Humerus

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Abstract

Percutaneous fixation offers many advantages (low risk of avascular necrosis, fibrosis and stiffness, improved cosmesis, low costs). However, it has been criticized because of the risk of pin migration, the loss of reduction and pin-site infection, a quite long learning curve, and a revision rate around 10 %. With the aim of reducing these complications, we use pins with a longer thread, to engage both the lateral cortex and the subchondral bone, and we stabilize the pins with an external fixator (the so-called hybrid technique) to increase the resistance to pullout and to reduce the importance of pin configuration in implant stability. The patient resting position depends on whether closed reduction (supine position) or open reduction (beach-chair position) is going to be performed. In the case of a two-fragment fracture, we use four retrograde pins; in three- and four-fragment fractures, two more antegrade pins are needed. We believe the majority of fractures can be treated with pins: in fact, in cases of complex fractures, the surgeon can perform an open reduction followed by percutaneous fixation. Percutaneous pinning is contraindicated in cases of fractures without a good lateral cortex, splitting of the humeral head, and highly comminuted tuberosities. The great advantage of this technique over other surgical treatments is the complete absence of hardware around the shoulder after the treatment has been completed.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, University of Turin Medical School, Mauriziano-Umberto I Hospital, Largo Turati 62, Turin, 10128, Italy

    Marco Assom

  2. Department of Orthopaedics and Traumatology, University of Turin Medical School, CTO-Maria Adelaide Hospital, Via Zuretti 29, Turin, 10126, Italy

    Enrico Bellato

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Correspondence to Enrico Bellato .

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  1. Department of Orthopaedics and Traumatology, CTO Hospital Turin, Turin, Italy

    Filippo Castoldi

  2. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Davide Blonna

  3. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Marco Assom

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Assom, M., Bellato, E. (2015). Percutaneous Fixation: When and How. In: Castoldi, F., Blonna, D., Assom, M. (eds) Simple and Complex Fractures of the Humerus. Springer, Milano. https://doi.org/10.1007/978-88-470-5307-6_6

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