Closed Reduction and Percutaneous Fixation of Proximal Humerus Fractures

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.