Summary
Objectives
Reduction and internal fixation of displaced proximal humeral fractures by minimally invasive percutaneous procedures. Restoration of shape and function of the shoulder joint.
Indications
Displaced proximal humeral fractures of Type A1, A3, B and C1 according to the AO classification.
Contraindications
Local infection.
Fractures not amenable to percutaneous reduction.
Impacted subcapital humeral fractures (Type A2).
Surgical Technique
Closed reduction by traction, ab- or adduction and rotation of the arm under image intensification. Manipulation of the head fragment with Kirschner wires, sharphooks, periosteal elevator or punch using the joystick technique. Reduction of displaced tuberosity fragments and internal fixation of the head fragment using cannulated small fragment screws. Fixation of the head fragment to the humeral shaft with 3 to 5 Kirschner wires inserted from distally.
Results
Seventy-seven patients (54 women, 23 men, mean age 63 years) were operated. Seven fractures were of Type A1, 26 of Type A3, 8 of Type B1, 31 of Type B2, 1 of Type B3, and 4 of Type C1. Fixation with Kirschner wires in 66 patients, of which 27 had an additional screw fixation and with screws alone in 11. Removal of Kirschner wires between the fourth and the sixth postoperative week. Screw removal only in 6 patients.
Sixty-four patients were assessed after 3 and 6 months using the Neer score [5]. After 3 months good and excellent results were observed in 41% of our patients. These results improved after 6 months to 70% in fractures of Type A and to 68.5% in fractures of Type B and C1 and reached at final follow-up (average 14.2 months) 72% for fractures of Type A, and 71% for fractures of Type B and C1; the mean Neer score was 85 and 81.5, respectively. Complications: One avascular necrosis, wire migration in 10 severely osteoporotic patients, fracture displacement after wire removal in 5 patients necessitating open reduction and refixation in 2 and a hemiarthroplasty in 3.
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Wirbel, R., Knorr, V., Saur, B. et al. Minimally invasive fixation of displaced proximal humeral fractures. Orthop Traumatol 7, 44–53 (1999). https://doi.org/10.1007/BF03180919
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DOI: https://doi.org/10.1007/BF03180919