Skip to main content

Advertisement

SpringerLink
Log in

The treatment of proximal humeral fractures with intramedullary titanium helix wire by 97 patients

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction:

The displaced proximal humeral fracture continues to be a problem and remains the “unsolved fracture”. Many guidelines for surgical treatment of different types of these fractures have been described. A conservative functional therapy is recommended as well as a closed or open reposition and internal fixation. Other authors prefer the primary prosthetic replacement of the displaced humeral head.

The purpose of this article is to describe a minimal invasive technique—the intramedullary titanium helix wire—and to analyse results and specific problems of this method compared to other techniques.

Materials and methods:

In a prospective study done over a period of 5 years from 1998 to 2002, 97 patients with two-, three- and four-part-fractures of the proximal humerus were treated with the intramedullary titanium helix wire and given follow-up clinical and radiological checks after 12 months. The functional outcome was evaluated with a 1-year follow-up in 95 of 97 patients.

Results:

Our 1-year results include: 41 very good, 24 good, 16 satisfactory, 14 poor (average 76 points Constant functional score, 30.7 points UCLA score).

Conclusion:

The advantages of the method arising from the results lie in both the simple operation approach without nerve lesions or wound infections, and also in the indirect, intramedullary splinting of the fracture without damage to the surrounding soft parts, while iatrogenic necroses of the humeral head can be avoided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bäthis H, Tingart M, Bouillon B, Tiling Th (2001) Die operative Therapie der proximalen Humerusfraktur. Ist die T-Platte noch ein zeitgemässes Osteosynthesverfahren? Zentralbl Chir 126:211–216

    Article  PubMed  Google Scholar 

  2. Bigliani LU (1990). Fractures of the proximal humerus. In: Rockwood CA, Matsen FA (eds) The shoulder. W.B. Saunders, Philadelphia

  3. Bosch U, Fremery RW, Skutek M, Lobenhoffer P, Tscherne H (1996) Hemiarthroplastic—a primary or secondary procedure for three- and four-part proximal humerus fractures in elderly patients?. Unfallchirurg 99:656–664

    Article  PubMed  CAS  Google Scholar 

  4. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orth 216:160–164

    Google Scholar 

  5. Damanakis K, Schaal O, Mann J, Müller KH (1996) Ein modifiziertes Behandlungskonzept bei Humeruskopffrakturen des älteren Menschen. Unfallchirurg 99:561–568

    PubMed  CAS  Google Scholar 

  6. Demirhan M, Kilicoglu O, Altinel L, Eralp L, Akalin Y (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures (discussion: 188–189). J Orthop Trauma March 17(3):181–188

    Google Scholar 

  7. Döhler JR, Feeser R (2000) The helix wire in proximal humeral fractures. A preliminary report on 20 patients. Osteosynthese International 8:224–227

    Google Scholar 

  8. Gautier E, Slongo T, Jakob RP (1992) Die Behandlung der subkapitalen Humerusfraktur mit dem Prevot-Nagel. Z. Unfallchir. Versicherungsmed. 85(3):145–155

    PubMed  CAS  Google Scholar 

  9. Habermeyer P, Schweiberer L (1991) Oberarmkopffrakturen, konservative und operative Differentialtherapie. Unfallchirurg 94:438–446

    PubMed  CAS  Google Scholar 

  10. Jaberg H, Warner JJP, Jakob RP (1992) Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg 74-A:508–515

    PubMed  CAS  Google Scholar 

  11. Jakob RP, Miniaci A, Anson PS, Jaberg H, Osterwalder A, Ganz R (1991) Fourpart valgus-impacted fractures of the proximal humerus. J Bone Joint Surg 73-B:295–298

    CAS  Google Scholar 

  12. Ko JY, Yamamoto R (1996) Surgical treatment of complex fracture of the proximal humerus. Clin Orthop Relat Res 327:225–237

    Article  PubMed  Google Scholar 

  13. Kollig E, Kutscha-Lissberg F, Roetman B, Mielke E, Muhr G, Hahn MP (2003) Primary hemiarthroplasty after complex fracture of the humeral head—functional late results. Zentralbl Chir. Feb 128(2):125–130

    Article  CAS  Google Scholar 

  14. Koval J, Blair B, Takei R, Kummer FJ, Zuckermann JD (1996) Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques. J Trauma 40:778–783

    Article  PubMed  CAS  Google Scholar 

  15. Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G, Resch H (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br Mar 86(2):217–219

    Article  CAS  Google Scholar 

  16. Kuner EH, Siebler G (1987) Luxationsfrakturen des proximalen Humerus—Ergebnisse nach operativer Behandlung. Eine AO-Studie über 167 Fälle. Unfallchirurgie 13:64–71

    Article  PubMed  CAS  Google Scholar 

  17. Laminger KA, Traxler H (1999) Osteosynthese proximaler Humerusfrakturen. Unfallchirurgie 25:154–164

    Article  Google Scholar 

  18. Lill H, Lange K, Prasse-Badde J, Schmidt a, Verheyden P, Echtermeyer V (1997) Die T-Platten Osteosynthese bei dislozierten proximalen Humerusfrakturen. Unfallchirurgie 23:183–190

    PubMed  CAS  Google Scholar 

  19. Lill H, Bewer A, Korner J, Verheyden P, Hepp P, Krautheim I, Josten C (2001) Konservative Therapie dislozierter proximaler Humerusfrakturen. Zentralbl Chir 126:205–210

    Article  PubMed  CAS  Google Scholar 

  20. Lill H, Hepp P, Rose T, Konig K, Josten C (2004) The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach-technique and first results. Zentralbl Chir. Jan; 129(1):43–48

    Article  CAS  Google Scholar 

  21. Neer CS II (1970) Displaced proximal humerus fractures. Part I. Classification and evaluation. J Bone Joint Surg 52(6):1077–1089

    PubMed  Google Scholar 

  22. Neer CS II (1970) Displaced proximal humeral fractures. Part II. Treatment of three part and four-part displacement. J Bone Joint Surg 52(6):1090–1103

    PubMed  Google Scholar 

  23. Norris TR, Green A, McGuigan FX (1995) Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures. J Shoulder Elbow Surg 4:271–280

    Article  PubMed  CAS  Google Scholar 

  24. Qidwai SA (2001) Treatment of proximal humeral fractures by intramedullary Kirschner wires. J Trauma Jun 50(6):1090–1095

    CAS  Google Scholar 

  25. Rader CP, Keller HW, Rehm KE (1992) Die operative Behandlung dislozierter 3- und 4-Segment-Frakturen des proximalen Humerus. Unfallchirurg 95:613–617

    PubMed  CAS  Google Scholar 

  26. Raissadat K, Struben PJ, van Loon CJ (2004) Helix wire osteosnthesis for proximal humeral fractures: unacceptable non-union rate in two- and three-part fractures. Arch Orthop Trauma Surg Apr 124(3):166–168

    Article  CAS  Google Scholar 

  27. Robinson CM, Christie J (1993) The two-part proximal humeral fracture: a review of operative treatment using two techniques. Injury 24(2):123–125

    Article  PubMed  CAS  Google Scholar 

  28. Robinson CM, Page RS, Hill RM, Sandes DL, Court-Brown CM, Wakefield AE (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am Jul 85-A(7):1215–1223

    Google Scholar 

  29. Schmal H, Klemt C, Südkamp NP (2004) Stellenwert der Schulterprothese bei der Behandlung der 4-Fragment-Fraktur des Oberarmkopfes. Unfallchirurg 107:575–582

    Article  PubMed  CAS  Google Scholar 

  30. Speck M, Lang FJH, Regazzoni P (1996) Proximale Humerusmehrfragment-frakturen—Misserfolge nach T-Platten-Osteosynthesen. Swiss. Surg. 2, Verlag Hans Huber, pp 51–56

  31. Stedtfeld HW, Attmanspacher W, Thaler K, Frosch B (2003) Fixation of humeral head fractures with antegrade intramedullary nailing. Zentralbl Chir. Jan 128(1):6–11

    Article  Google Scholar 

  32. Sturzenegger M, Fornaro E, Jakob RP (1982) Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg 100:249–259

    Article  PubMed  CAS  Google Scholar 

  33. Szyszkowitz R, Seggl W, Schleifer P, Cundy PJ (1993) Proximal humeral fractures: management techniques and expected results. Clin Orthop 292:13–25

    PubMed  Google Scholar 

  34. Towfigh H, Bühl W, Obertacke U (1993) Behandlungsergebnisse nach konservativer und operativer Versorgung von proximalen Oberarmfrakturen. Aktuel Traumatol 23:354–360

    PubMed  CAS  Google Scholar 

  35. Traxler H, Surd R, Laminger KA, Windisch A, Sora MC, Fibras W (2001) The treatment of subcapital humerus fracture with Dynamic Helix Wire and the risk of concomitant lesion of the axillary nerve. Clin Anat 14:418–423

    Article  PubMed  CAS  Google Scholar 

  36. Wachtl SW, Marti CB, Hoogewoud HM, Jakob RP, Gautier E (2000) Treatment of proximal humerus fracture using multiple intramedullary flexible nails. Arch Orthop Trauma Surg 120(3–4):171–175

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sportorthopädie Bern, Klinik Sonnenhof, Buchserstr 30, 3006, Bern, Switzerland

    Ottmar Gorschewsky, Andrej Puetz, Andreas Klakow & Martin Pitzl

  2. Orthopädische Universitätsklinik, Otto-von-Guericke Universität, Magdeburg, Germany

    Wolfram Neumann

Authors
  1. Ottmar Gorschewsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrej Puetz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas Klakow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Pitzl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolfram Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ottmar Gorschewsky.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gorschewsky, O., Puetz, A., Klakow, A. et al. The treatment of proximal humeral fractures with intramedullary titanium helix wire by 97 patients. Arch Orthop Trauma Surg 125, 670–675 (2005). https://doi.org/10.1007/s00402-005-0027-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-005-0027-z

Keywords

Search

Navigation