Close reduction and percutaneous fixation of unstable fracture proximal humerus: midterm clinical outcome

Abstract

Background Proximal humeral fractures are common injuries and sharply increase in elderly patients, especially those over the age of 60 years. Conservative treatment usually leads to nonsatisfactory results. That is why, open reduction and internal fixations is essential, but it increases the risk of avascular necrosis, infection, and joint stiffness. Minimally invasive techniques, with less disruption of soft tissue attachments, may offer advantages over conventional fixation. Close reduction and percutaneous fixation of proximal humeral reduces risk from soft tissue dissection and may reduce the fracture indirectly, achieving provisional fixation for anatomic healing. Aim To evaluate the results of close reduction and percutaneous fixation of unstable fracture proximal humerus with threaded K-wire and cannulated screws. Patients and methods A prospective study was conducted over a period of 48 months of 54 patients who presented with unstable fracture proximal humerus (two-part, three-part, and four-part fracture) aiming for close reduction and percutaneous fixation by threaded K-wire and cannulated screws of 4 mm. The mean age was 49 years (29–72 years). The mean follow-up was 20 months (6–30 months). Results were assessed according to the Constant score. Only 50 patients completed their follow-up. Results All fractures united within an average of 6 weeks (6–8 weeks). No intraoperative complications occurred. Implant removal was performed after complete radiological union within 8–10 weeks after the initial surgery. In 10 (20%) cases, secondary impaction of the humerus leads to perforation of K-wires through the articular surface requiring premature removal of the entire implant after 4–5 weeks. A total of 35 (70%) patients had a Constant score more than 90, nine (18%) patients had a score more than 85, and the rest six (12%) patients had a score less than 80. In comparison with the normal side, 40 (80%) patients had excellent or good results, seven (14%) patients had fair results, and three (6%) patients had poor results. Conclusion Closed reduction and percutaneous fixation of unstable proximal humerus fractures is a useful highly demanding technique in select patients. The rationale of minimizing soft tissue dissection to preserve head vascularity is a very sound reason to select this approach in some three-part and four-part fractures, which is the key to success regarding the functional results of this technique.