Abstract
Purpose
The Kapandji pinning was initially described for the treatment of surgical neck fractures of the humerus in young patients. The aim of our study was to evaluate functional and radiological outcomes of the Kapandji modified technique in displaced complex three- and four-part fractures.
Methods
From 2005 to 2009, 32 patients (23 three-part and nine four-part fractures) were included retrospectively. The mean age was 63 years old (range, 22–86), and the dominant shoulder was involved in 40 % of the cases.
Results
At a mean follow up of 25 months (12–72), the mean absolute Constant score achieved 68 points (35–98) and adjusted score 80 % (47–100). Patients had an average forward elevation of the shoulder of 132° (80°–180°), an average external rotation of 36° (0°–90°), and an average internal rotation to the level of L1 (sacrum to the level of T6). The older the patients were the worst was the active anterior elevation recovery (r = −0.3; p = 0.01). Reduction and fixation of initial varus-displaced fractures was not as reliable as in valgus. In eight cases (25 %), K-wire migrations were observed and were correlated with age over 70 years old (p = 0.001). Two partial osteolysis of the greater tuberosity and two avascular necrosis of the humeral head (one was associated with a non-union) were identified. Moreover, three patients developed adhesive capsulitis.
Conclusion
The Kapandji technique with fixation of tuberosities provides satisfactory results for the treatment of complex proximal fractures of the humerus. However, we do not recommend this technique for patients older than 70 years and in cases of varus displaced fractures.
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References
Boileau P, Walch G (1997) The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br 79-B:857–865
Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Should Elb Surg 11:401–412
Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697. doi:10.1016/j.injury.2011.12.007
Egol KA, Sugi MT, Ong CC, Montero N, Davidovitch R, Zuckerman JD (2012) Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Should Elb Surg 21:741–748. doi:10.1016/j.jse.2011.09.017
El-Alfy BS (2011) Results of the percutaneous pinning of proximal humerus fractures with a modified palm tree technique. Int Orthop 35:1343–1347. doi:10.1007/s00264-011-1231-9
Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191. doi:10.1097/ BOT.0b013e3180333094
Hardeman F, Bollars P, Donnelly M, Bellemans J, Nijs S (2012) Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury 43:153–158. doi:10.1016/j.injury.2011.04.003
Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S (1992) The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am 74-A:491–500
Kapandji A (1989) L’ostéosynthèse par la technique des broches “en palmier” des fractures du col chirurgical de l’humérus. Ann Chir Main 8:39–52
Keener JD, Parsons BO, Flatow EL, Rogers K, Williams GR, Galatz LM (2007) Outcomes after percutaneous reduction and fixation of proximal humeral fractures. J Should Elb Surg 16:330–338. doi:10.1016/j.jse.2006.09.006
Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. doi:10.1016/j.injury.2011.01.017
Lanting B, MacDermid J, Drosdowech D, Faber KJ (2008) Proximal humeral fractures: a systematic review of treatment modalities. J Should Elb Surg 17:42–54. doi:10.1016/j.jse.2007.03.016
Le Bellec Y, Masmejean E, Cottias P, Alnot JY, Huten D (2002) Ostéosynthèse des fractures de l’humérus proximal par brochage en palmier. Rev Chir Orthop Reparatrice Appar Mot 88:342–348
Monin S, van Innis F (1999) Fracture de l’extrémité proximale de l’humérus traitée par embrochage centro-médullaire selon Kapandji. Revue de 21 cas. Acta Orthop Belg 65:176–181
Namdari S, Voleti PB, Mehta S (2012) Evaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment. J Should Elb Surg 21:1787–1795. doi:10.1016/j.jse.2012.04.003
Neer CS II (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52-A:1077–1089
Neer CS II (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103
Nolan BM, Kippe MA, Wiater JM, Nowinski GP (2011) Surgical treatment of displaced proximal humerus fractures with a short intramedullary nail. J Should Elb Surg 20:1241–1247. doi:10.1016/j.jse.2010.12.010
Ogawa K, Kobayashi S, Ikegami H (2011) Retrograde intramedullary multiple pinning through the deltoid “V” for valgus-impacted four-part fractures of the proximal humerus. J Trauma 71:238–244. doi:10.1097/TA.0b013e318212819e
Resch H, Povacz P, Frohlich R, Wambacher M (1997) Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79-B:295–300
Roberts VI, Komarasamy, Pandey R (2012) Modification of the Resch procedure: a new technique and its results in managing three- and four-part proximal humeral fractures. J Bone Joint Surg Br 94-B:1409–1413. doi:10.1302/0301-620X.94B10.28692
Robinson CM, Page RS (2003) Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am 85-A:1647–1655
Robinson PM, Harrison T, Cook A, Parker MJ (2012) Orthopaedic injuries associated with hip fractures in those aged over 60 years: a study of patterns of injury and outcomes for 1971 patients. Injury 43:1131–1134. doi:10.1016/j.injury.2012.03.012
Shah N, Iqbal HJ, Brookes-Fazakerley S, Sinopidis C (2011) Shoulder hemiarthroplasty for the treatment of three and four part fractures of the proximal humerus using Comprehensive® Fracture stem. Int Orthop 35:861–867. doi:10.1007/s00264-010-1083-8
Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma 23:113–119. doi:10.1097/BOT.0b013e31819344bf
Sperling JW, Cuomo F, Hill JD, Hertel R, Chuinard C, Boileau P (2007) The difficult proximal humerus fracture: tips and techniques to avoid complications and improve results. Instr Course Lect 56:45–57
Torrens C, Corrales M, Vilà G, Santana F, Cáceres E (2011) Functional and quality-of-life results of displaced and nondisplaced proximal humeral fractures treated conservatively. J Orthop Trauma 25:581–587. doi:10.1097/BOT.0b013e318210ed2f
Werner A, Bohm D, Ilg A, Gohlke F (2002) Die intramedulläre drahtosteosynthese nach Kapandji bei der proximalen humerusfraktur. Unfallchirurg 105:332–337
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Bonnevialle, N., Ibnoulkatib, A., Mansat, P. et al. Kapandji pinning and tuberosities fixation of three- and four-part fractures of the proximal humerus. International Orthopaedics (SICOT) 37, 1965–1971 (2013). https://doi.org/10.1007/s00264-013-1926-1
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DOI: https://doi.org/10.1007/s00264-013-1926-1