Summary
Goal of Surgery
Stable internal fixation of extraarticular proximal humeral fractures.
Indications
Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision.
Epiphysiolysis.
Fracture-dislocation of the humeral head.
Contraindications
Pathological fractures.
Four part fractures.
Segmental fractures of the humerus.
Positioning and Anaesthesia
Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board.
General or regional anaesthesia.
Surgical Technique
Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly at the metaphyseal level.
Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which is controlled by image intensification.
Postoperative Management
Temporary immobilization in a sling.
Passive and active assisted movements after a few days.
Active movements after 2 weeks.
Removal of wires after 3 months.
Possible Complications
Fracture of the humerus at the site of the cortical window. Injury to the radial nerve.
Results
32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6, mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis nor infection.
Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months.
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Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France.
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Bonnevialle, P., Bellumore, Y. & Mansat, M. Ascending cluster pinning of the humerus inserted through the deltoid tuberosity. Operat Orthop Traumatol 8, 243–251 (1996). https://doi.org/10.1007/BF02510185
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DOI: https://doi.org/10.1007/BF02510185