Advertisement

Closed Reduction and Percutaneous Fixation of Proximal Humerus Fractures

  • Alexander Auffarth
  • Philipp Moroder
  • Herbert Resch
Chapter

Abstract

A technique of percutaneous pinning of proximal humerus fractures had already been described in 1962. Due to the problem of K-wire migration which often lead to a loss of reduction, this method of fixation had consequently been less favored. The main goal with the further on described technique is not necessarily to achieve a perfectly anatomical reduction. Instead, the aim is to gently manipulate a highly displaced fracture in order to correctly align the fragments among each other, thus revert the fracture into a minimally displaced one. The first step of any treatment with the humerus block, is to fix the block to the humeral shaft by a cannulated screw at about 5 cm below the subcapital fracture level. Then, two 2.5 mm K-wires are introduced through the block into the humeral shaft and left in place just below the fracture while the head fragment is reduced. Once, the reduction is achieved, the head fragment is fixed by the two K-wires by driving them into the humeral head so their tips get a grip in the subchondral bone. If indicated, still displaced tuberosities are fixed by percutaneously inserted single screws. Based on the author’s experience, proximal humerus fractures can practically be classified as varus and valgus types which are determined by the position of the head fragment. Additionally, impacted fracture types can be differentiated from avulsed ones. Based on these determinations, the individually most promising technique of closed reduction and percutaneous fixation of the four most common fracture types are described in detail.

Keywords

Humeral Head Constant Score Great Tuberosity Humeral Shaft Proximal Humerus Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Bohler J. Treatment of open diaphysial fractures of the long bones. Acta Orthop Belg. 1962;28:450–76.PubMedGoogle Scholar
  2. 2.
    Stableforth PG. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br. 1984;66:104–8.PubMedGoogle Scholar
  3. 3.
    Svend-Hansen H. Displaced proximal humeral fractures. A review of 49 patients. Acta Orthop Scand. 1974;45:359–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury. 1998;29:349–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study. J Bone Joint Surg Br. 1993;75:132–6.PubMedGoogle Scholar
  6. 6.
    Resch H. Fractures of the humeral head. Unfallchirurg. 2003;106:602–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13:427–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Nho SJ, Brophy RH, Barker JU, et al. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am. 2007;89 Suppl 3:44–58.PubMedCrossRefGoogle Scholar
  9. 9.
    Brunner A, Weller K, Thormann S, et al. Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the Humerusblock. J Orthop Trauma. 2010;24:407–13.PubMedCrossRefGoogle Scholar
  10. 10.
    Hirzinger C, Tauber M, Resch H. Proximal humerus fracture: new aspects in epidemiology, fracture morphology, and diagnostics. Unfallchirurg. 2011;114:1051–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Resch H, Povacz P, Frohlich R, et al. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295–300.PubMedCrossRefGoogle Scholar
  12. 12.
    Bogner R, Hubner C, Matis N, et al. Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br. 2008;90:1602–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Roberts VI, Komarasamy B, Pandey R. 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. 2012;94:1409–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Hessmann MH, Rommens PM. [Osteosynthesis techniques in proximal humeral fractures]. Chirurg. 2001;72:1235–45.PubMedCrossRefGoogle Scholar
  15. 15.
    Brunner A, Resch H, Babst R, et al. The Humerusblock NG: a new concept for stabilization of proximal humeral fractures and its biomechanical evaluation. Arch Orthop Trauma Surg. 2012;132:985–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Robinson CM, Page RS, Hill RM, et al. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003;85-A:1215–23.PubMedGoogle Scholar
  17. 17.
    Zyto K, Wallace WA, Frostick SP, et al. Outcome after hemiarthroplasty for three- and four-part fractures of the proximal humerus. J Shoulder Elbow Surg. 1998;7:85–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Demirhan M, Kilicoglu O, Altinel L, et al. Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma. 2003;17:181–8. discussion 188–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Boyle MJ, Youn SM, Frampton CM, et al. Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg. 2013;22:32–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Alexander Auffarth
    • 1
  • Philipp Moroder
    • 1
  • Herbert Resch
    • 1
  1. 1.Traumatology and Sports InjuriesParacelsus Medical University SalzburgSalzburgAustria

Personalised recommendations