Abstract
Background: Proximal humerus fractures represent 4-5% of over-all fractures. In patients above 40 years of age, it accounts for 75% of all humerus fractures. Fractures of the proximal end of the humerus oftentimes represent a management dilemma with the multiple surgical options available to deal with them. Objective: To evaluate the functional and radiographic outcomes of the percutaneous pinning techniques in the management of two-part and three-part proximal humerus fracture. Patients and Methods: A case series of 25 patients, functional outcome was determined by ASES and Constant scores and multiple radiographic views were taken to assess the fracture union, mal-union, and the presence of avascular necrosis. Results: ASES score of the whole group was 87.27 while the mean Constant score was 79.04. Only 16% of the entire group developed varus malunion (defined by Neck-Shaft-Angle <=120degrees). Moreover, 16% of the whole group developed OA of the glenohumeral joint. Conclusion: This study supports that the percutaneous close reduction and pinning technique is an effective and reliable surgical technique in the management of closed two-part and three-part proximal humerus fractures in adults. Appropriate preoperative planning is important to achieve a successful surgical result, and regular postoperative follow-up and rehabilitation are essential to get an optimum functional outcome. Keywords: Proximal humerus fracture, percutaneous pinning, upper extremity surgery, trauma surgery, Clinical outcomes, Percutaneous fracture fixation
Highlights
Proximal humerus fractures, defined as all humerus fractures [2]
Displaced three-part and fourpart fractures markedly alter the articular congruity of the glenohumeral joint and have the highest likelihood of disrupting the major blood supply to the proximal humerus [5]
The surgical technique of close reduction and percutaneous pinning was first described by Bohler [6] for the treatment of proximal humerus fracture in paediatric age group; this technique has been adopted for adult fractures as well
Summary
Proximal humerus fractures, defined as all humerus fractures [2]. Fractures of the fractures occurring at or proximal to the proximal end of the humerus oftentimes surgical neck of the humerus, represent 4-5% represent a management dilemma. of over-all fractures [1]. Displaced three-part and fourpart fractures markedly alter the articular congruity of the glenohumeral joint and have the highest likelihood of disrupting the major blood supply to the proximal humerus [5]. Surgical management of these fractures includeing: close reduction and percutaneous pinning, open reduction and internal fixation by multiple options including: plate and screws, fixed-angle device, transosseous suture fixation and locked intramedullary nail. The surgical technique of close reduction and percutaneous pinning was first described by Bohler [6] for the treatment of proximal humerus fracture in paediatric age group; this technique has been adopted for adult fractures as well.
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