Three-part Proximal Humerus Fractures Research Articles

Functional results of deltoid split minimally invasive osteosynthesis for neer type 3 proximal humerus fractures

We aimed to evaluate the short-term functional and radiological outcomes of the minimally invasive fixation of three-part proximal humerus fractures without using calcar screws. Twenty patients were treated with the minimally invasive approach using locking plate-screws. The relationship between the cephalo-diaphyseal angles and the functional outcomes were evaluated. The mean follow-up time were 22.7 months. The mean Constant-Murley score of the patients was 83.7. The modified Constant-Murley score was excellent in 16 and good in four patients. A statistically significant difference was detected between cephalo-diaphyseal angles. Osteosynthesis with minimally invasive plate-screw and deltoid splitting application is encouraging with its satisfactory results in three-part fractures of the humerus; however, the total complication rate of 35% should not be ignored. In addition, in order to prevent a significant varus collapse and angular loss, the fracture subgroups should be studied in detail and additional measures should be taken based on the fracture type.

Subgroups and differences of fixation in 3-part proximal humerus fractures.

This study aimed to determine the morphological differences of three-part proximal humerus fractures, the group in which plate screw fixation is most frequently used, and to evaluate the functional and radiological results of the methods applied for different subgroups. Twenty-nine patients (6 males and 23 females) with three-part proximal humerus fractures were in the study, with an average age of 64. The patients were in three groups according to their fracture types. Group 1 included eight patients with valgus impaction fracture. Group 2 included eleven patients with easily achieved stability after reduction. Group 3 consisted of ten patients with procurvatum varus angulation, a significant displacement between fragments, and in whom medial cortical continuity was not maintained without fixation. All patients underwent surgery with a minimally invasive deltoid split approach method and locked ana-tomic plate screw osteosynthesis. In group 1 patients, the space in the area where valgization is present in the head was filled with cortico-cancellous allografts. No grafting or metaphyseal compression took place in Group 2 patients. In group 3 patients, the metaphyseal compression technique was applied to the bone defect area. Cephalodiaphyseal angles (CDA) were measured at the postoperative and final follow-up. The constant Murley score made the functional evaluation. The patients were followed for an average of 27.6 months, and the union was present in all patients for an average of 3.6 months. Early screw migration was present in three patients, and late screw migration was in one patient. There were twenty-four excellent and 5 good results. CDA decreased from 139.42° to 136.13°. A statistically significant difference was present between the values of Groups 2 and 3 in the final control CDA of the groups. In this study, the functional scores of grafting stable valgus-impacted fractures and metaphyseal compression of unstable fractures with insufficient medial support were as good as stable 3-part fractures. Considering neer type 3 fractures should be evaluated with their subgroups, and fixation and stability-enhancing solutions specific to the groups are essential.

A study of Proximal Humerus Fractures treated by Locking Compression plating

Abstract Background: The treatment of proximal humerus fractures is always a challenge for the Orthopedic surgeon. Proximal humeral fractures are a regular presence in clinics. In the past, the standard treatment method was conservative. The results and functional outcomes, on the other hand, were not favorable. The functional outcomes have been known to improve after the development of locking compression plates. The purpose of this study was to see how functional proximal humerus fractures were treated with locking compression plates fared. Methods: This cross-sectional interventional prospective study was carried out in the Department of Orthopedics, Prathima Institute of Medical Sciences. The study included all adult patients with closed two-part and three-part proximal humerus fractures who were reported within a week after the incident. Based on the sample size calculations and inclusion and exclusion criteria a total of n=35 patients were included in the study. Patients were followed up for 12months after surgery using a typical surgical method with a locking compression plate. Results: n=35 patients out of which n=19(54.2%) were males and n=16 (45.7%) were females. The distribution based on age involved in patients with fractures showed equal preponderance among 31-35 years and 20-25 years with n=9(25.71%).Neer's classification of fractures of proximal humerus was followed in this study. Most of the patients in n=25 (71.42%) cases were having Neer's Two-part fractures and three-part fractures were found in n=8(22.8%) and four-part in n=2(5.7%). The overall results in the study were 65.71% of patients had excellent results,20% had good results,8.5% had satisfactory results and 5.7% had poor results. Conclusion: Locking plates are a preferable therapeutic choice for proximal humerus fractures, particularly when the bone quality is poor and the fracture is comminuted. Complication rates can be reduced by using good surgical techniques and selecting the right situations. Proximal humeral internal locking plates continue to provide strong overall functionality.

A prospective study on surgical management of neer’s two-part and three-part proximal humerus fractures by philos plating and its functional outcome

Background and Objectives: Fractures of proximal humerus are the second most common fracture of upper limb accounting 4% to 5% of all fractures. There are different modalities of surgical treatment like multiple k-wire fixation, proximal humeral nailing, locking plate osteosynthesis, TBW and Hemiarthroplasty of shoulder. The mode and type of fracture fixation depends on the fracture pattern, bone quality, age and activity of patient. The goal is to achieve near anatomical reduction and stable fixation so as to achieve early mobilization. Method: A Prospective study of 30 cases of surgically managed fractures of Proximal Humerus Using Proximal Humerus (PHILOS) Locking Compression Plates undertaken at Department of Orthopaedics, J.J.M. Medical College, Davangere from 1st August 2019 to 31st July 2021 who follow Inclusion and Exclusion criteria. Post operative functional outcome was assessed by using Constant And Murley Scoring. Result: The most common age group included in our study was between 50-60 years (50%) with mean age group being 47.66 years.20 patients had a fracture of right proximal humerus and10 had of the left side.Our study included 14(47)% patients with 2 part surgical neck fracture, 12(40%) with 3part surgical neck with greater tuberosity, 3(10%) with 3 part surgical neck with lesser tuberosity and 1(3%)patient with 2 Part greater tuberosity fracture. Functional results were 6(20%) patients had excellent result. 18(50%) patients had good, 4 (13.33%) patients had moderate and 2(6.66%) patients had poor result at 1 year follow up. The average Constant And Murley Score being 76.9. Conclusion: PHILOS plate appears to be a new generation promising implant for the internal fixation of proximal humerus fractures. The design provides stable fixation even in osteoporotic bone and allows early mobilization of the joint. It is suitable for two-part, three-part fractures in young and in elderly patients providing that the correct surgical technique is used.

Outcomes of Percutaneous Pinning Technique in the Management of Two-Part and Three-Part Proximal Humerus Fracture in Adults

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

Minimally invasive percutaneous plate osteosynthesis for Neer three-part fractures of proximal humerus in young adults

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of Neer three-part fractures of the proximal humerus in young adults. Methods A retrospective analysis was performed of the 46 patients aged < 65 years with Neer three-part fracture of the proximal humerus from March 2010 to December 2016. MIPPO with locking proximal humerus plate (LPHP) was used in 23 of them who were 12 men and 11 women with an average age of 41.6±1.2 years; open reduction and internal fixation (ORIF) with LPHP was used in the other 23 patients who were 14 men and 9 women with an average age of 42.2±1.6 years. The 2 groups were compared in terms of operation time, intraoperative bleed-ing, fracture healing time and shoulder function by Neer scoring at the last follow-up. Results The average follow-up (13.4±1.2 months) for the MIPPO groups was not statistically different from that for the ORIF group (14.2±2.4 months) (P >0.05). The MIPPO group reported significantly shorter operation time (105±15 min), significantly less intraoperative bleeding (140±50 mL), significantly shorter fracture healing time(4.2±0.6 months), and significantly higher shoulder Neer scores (88.6±3.4) than the ORIF group (120±20 min, 320±40 mL, 5.4±1.2 months, and 81.6±2.2, respectively) (P 0.05). Conclusion MIPPO with LPHP may be obviously advantageous over ORIF with LPHP in the treatment of proximal humeral fractures in young adults. Key words: Shoulder fractures; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive

Outcomes of intramedullary nailing for acute proximal humerus fractures: a systematic review.

BackgroundWhile proximal humerus fractures remain common within the elderly population, the optimal treatment method remains controversial. Intramedullary nailing has been advocated as an effective and less invasive surgical technique. The purpose of this study is to elucidate the demographics, outcomes, and complications of intramedullary nailing for acute, displaced proximal humerus fractures.Materials and methodsMultiple computerized literature databases were used to perform a systematic review of English-language literature. Studies that met our stated criteria were further assessed for the requisite data, and when possible, similar outcome data were combined to generate frequency-weighted means.ResultsFourteen studies with 448 patients met our inclusion criteria. The frequency-weighted mean age was 64.3 years, and mean follow-up was 22.6 months. Females accounted for 71 % of the included patients. Three-part fractures (51 %) were most commonly treated. The overall frequency-weighted mean Constant score was 72.8, and American Shoulder and Elbow Surgeons (ASES) score was 84.3. Frequency-weighted mean forward elevation, abduction, extension, and external rotation were 137.3°, 138.4°, 33.8°, and 43.1°, respectively. The Constant score for two- and three-part fractures was significantly higher than for four-part fractures (p = 0.007 and p = 0.0009, respectively). The reoperation rate for two-, three-, and four-part fractures was 13.6, 17.4, and 63.2 %, respectively.ConclusionsIntramedullary nailing of acute, displaced two- and three-part proximal humerus fractures yields satisfactory clinical outcomes, although reoperation and complication rates remain high. Use of this implant for four-part fractures cannot be recommended until further clinical studies with larger patient numbers are available.Level of evidenceLevel IV, Systematic review.

Locked plate fixation for proximal humerus fractures in elderly osteoporotic patients

Background Proximal humeral fractures in elderly osteoporotic bones represent a challenge to orthopedic surgeons; many options for treatment are now available; yet, the optimum method with best results and minimal complications is not well established. Patients and methods Twenty-six osteoporotic or osteopenic patients with three-part or four-part proximal humerus fractures according to the Neer classification who underwent surgical fixation with locked plates through the standard deltopectoral approach were included in the study. The clinical outcome was evaluated with the Constant-Murley score. Results The average Constant score corresponds to 76.5 points, and the mean patient age in this study was 61 years. The average Constant score for pain was 13 points, strength 17 points, activities of daily living 17.9 points, and range of motion 28.6 points. All 26 fractures healed with a mean time of 11.5 weeks (8-16 weeks) and were followed for an average of 17 months. Conclusion Locked plate fixation for three-part and four-part fractures of the proximal humerus in osteopenic or osteoporotic patients is a good and reliable method of fixation with limited complications.

Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model

BackgroundOsteosynthesis of unstable proximal humerus fractures still remains challenging. The aim of this study was to investigate two intramedullary nailing techniques with different locking options in a three-part fracture model and prove whether two new fixation concepts, introducing additional locking screw-in-screws inserted through the head of the proximal screws, and a calcar screw, provide better stability. MethodsA biomechanical testing model for three-part proximal humerus fractures including cyclic axial loading with increasing peak load and simultaneous pulling forces at the rotator cuff was used to test 12 pairs of human cadaver humeri, assigned to four groups and instrumented with either Targon PH (T1) or MultiLoc PHN in 3 different configurations (standard M1; two additional screw-in-screw M2; one additional calcar screw and two screw-in-screw M3). FindingsInitial range of motion in internal–external rotation and mediolateral translation was smallest in M3 (1.82°; 0.11mm), biggest in T1 (3.63°; 0.51mm) and significantly different between these two groups (p=0.02 and p=0.04, respectively). M3 showed minimum head migration along the nail and varus tilting after 5000 cycles (0.31mm; 0.20°) and 10000 cycles (1.59mm; 0.34°). M2 and M3 performed better than M1 and T1 regarding varus collapse. The highest number of cycles to failure was observed for M3 (20733) and the lowest for T1 (10083) with significant difference between these two groups (p=0.04). InterpretationThe configuration with two screw-in-screw and a calcar screw was superior in most aspects. The screw-in-screws were found to contribute against varus collapse. Both new fixation concepts could provide better stability in proximal humerus fractures.

Range of motion implications of proximal humerus fractures: a case study

BackgroundFunctional outcome in surgical treatment of Neer three- and four-part proximal humerus fractures (PHF) varies greatly and depends on multiple parameters. Important parameters are the amount and direction of displacement and the necessary reduction of fragments during surgery. These are patient-specific parameters and are difficult to determine using traditional modalities such as radiographs and computed tomography (CT).MethodsA 58-year-old female patient was reported in the emergency department with a three-part PHF. CT scan images showed that the humeral shaft was medialised and internally rotated, but with a marginally displaced greater tuberosity fragment. Using a bone-determined range of motion (ROM) simulation system, we analysed the CT scan and calculated the required correction needed to prevent post-operative impingement. The fracture was reduced and stabilised by a locking plate, realigning the medialised and internally rotated humeral shaft. The post-operative bone-determined ROM was determined using a post-operative CT scan and the motion simulation system.ResultsROM limitations due to bony impingement visible in the simulations of the pre-operative CT scan had mostly disappeared in the simulations of the post-operative CT scan. Twelve weeks post-surgery the patient has regained close to 80% of her ROM.ConclusionsThis case demonstrates the applicability of a new diagnostic tool that can be used to identify bony impingement and helps in making the decision for conservative or surgical treatment of a PHF. The simulation of post-trauma function was indicative of functional outcome. This supports our claim that the system may be used to facilitate the treatment decision regarding PHF.

Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model

Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model

Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model

Background The optimal surgical treatment for displaced proximal humeral fractures is still controversial. A new implant for the treatment of three-part fractures has been recently designed. It supplements the existing Expert Humeral Nail with a locking plate. We developed a novel humeral cadaveric model and the existing implant and the prototype were biomechanically compared to determine their ability in maintaining interfragmentary stability. Methods The bone mineral density of eight pairs of cadaveric humeri was assessed and a three-part proximal humeral fracture was simulated with a Greater Tuberosity osteotomy and a surgical neck wedge ostectomy. The specimens were randomly assigned to either treatment. A bone anchor simulated part of a rotator cuff tendon pulling on the Greater Tuberosity. Specimens were initially tested in axial compression and afterward with a compound cyclic load to failure. An optical 3D motion tracking system continuously monitored the relative interfragmentary movements. Findings The specimen stabilized with the prototype demonstrated higher stiffness ( P = 0.036) and better interfragmentary stability ( P values < 0.028) than the contralateral treated with the existing implant. There was no correlation between the bone mineral density and any of the investigated variables. Interpretation The convenience of this new IM-nail and locking plate assembly must be confirmed in vivo but the current study provides a biomechanical rationale for its use in the treatment of three-part proximal humeral fractures. The improved stability could be advantageous in particular when medial buttress is missing, even in osteoporotic bone.

Osteossíntese das fraturas da extremidade proximal do úmero com sistema de placa de ângulo fixo com parafusos bloqueados: técnica e resultados

OBJETIVO: Descrever os resultados do tratamento cirurgico das fraturas da extremidade proximal do umero com a placa de sistema bloqueado Philos. METODOS: Entre marco de 2003 e outubro de 2004 foram avaliados, de forma prospectiva, 24 de 26 pacientes com fratura da extremidade proximal do umero tratados com a placa Philos. A media de seguimento foi de 12 meses e da idade dos pacientes, de 57 anos. Seis pacientes tinham fraturas em quatro partes, 11 em tres partes e nove em duas partes. A avaliacao clinica foi feita por meio dos criterios da University of California at Los Angeles (UCLA). RESULTADOS: A media do escore da UCLA foi de 30 pontos (17-35). Todas as fraturas consolidaram. Em tres pacientes a fratura consolidou em varo. Nesses, o indice da UCLA medio foi de 27 pontos. CONCLUSAO: A osteossintese com a placa Philos permite fixacao estavel com bom resultado funcional.

Tetracycline labeling as a measure of humeral head viability after 3- or 4-part proximal humerus fracture

Specifically located humeral head biopsies from three-part proximal humerus fractures taken at the time of hemiarthroplasty will show greater tetracycline labeling under fluorescent microscopy than those biopsies taken from four-part fractures. Additionally, biopsies from younger patients would show greater fluorescence than older patients. Nineteen consecutive adult patients (range 43-83 years) underwent hemiarthroplasty as definitive treatment for 20 displaced three- and four-part proximal humerus fractures after having received 500 mg of tetracycline hydrochloride orally every six hours for the immediate five preoperative days. Humeral head biopsies were taken from four pre-determined locations intraoperatively. The biopsies were prepared and analyzed with fluorescent microscopy. All specimens in each biopsy location demonstrated fluorescence. There was no difference between the mean rank gray values for the four biopsy locations (p = 0.78 with the Friedman test). There was no difference between the mean rank gray values for the four biopsy locations when analyzed according to three-part vs four-part fracture (p > 0.05 with the Mann-Whitney test). There was an inverse relationship between age and fluorescence for the anterosuperior biopsy location (p = 0.033 with Spearman correlation). Vascular supply is preserved in displaced three- and four-part proximal humerus fractures. With intact vascularity to the humeral head, head-preserving techniques utilizing stable, site-specific fixation and minimal dissection should be considered in the treatment of displaced three- and four-part proximal humerus fractures. Vascular supply is preserved in displaced three- and four-part proximal humerus fractures, especially in younger patients in the anterosuperior aspect of the humeral head. Basic Science Study.

OSTEOSYNTHESIS OF PROXIMAL HUMERAL END FRACTURES WITH FIXED-ANGLE PLATE AND LOCKING SCREWS: TECHNIQUE AND RESULTS

Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. Method: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria. Results: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. Conclusion: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.

The importance of patient selection for the treatment of proximal humerus fractures with percutaneous technique

We evaluated the indications and disadvantages of percutaneous technique for proximal humerus fractures in relation to complications encountered in osteoporotic elderly patients and the importance of patient selection. The study included 18 patients (10 men, 8 women; mean age 48 years; range 14 to 89 years) who underwent percutaneous fixation (closed reduction and pin fixation with K-wires or Schanz screws) for proximal humerus fractures. Eight patients were beyond 60 years of age. According to the Neer classification, five patients had two-part, 13 patients had three-part neck fractures. The patients were evaluated with range of motion of the shoulder, radiographs, and the Disability of Arm Shoulder and Hand questionnaire (DASH). The mean follow-up was 23 months (range 8 to 60 months). The mean shoulder abduction was 134 degrees (range 30 degrees to 160 degrees) and the mean elevation was 118 degrees (range 30 degrees to 140 degrees). Full range of motion of the shoulder was achieved in 11 patients (61.1%), including all with two-part fractures. Abduction losses of 60 degrees to 130 degrees and less than 30 degrees were seen in four patients and three patients, respectively, all of whom were older than 60 years. The mean DASH score was 18 (range 0 to 77). Fourteen patients having a score of less than 10 had no pain or functional complaints. Four patients with a score of more than 10 were older than 70 years. Pin migration was observed in seven patients (38.9%), all of whom were over 60 years of age. One patient required revision with partial prosthesis. Nonunion was seen in one patient (5.6%) and malunion with a varus/valgus deformity occurred in four patients (22.2%). None of the patients developed avascular necrosis. Percutaneous fixation may be preferred in the treatment of two-part and carefully-selected three-part proximal humerus fractures. Due to high complication rate, patient selection is of primary importance among elderly patients.

Percutaneous Plate Fixation of Two- and Three-part Proximal Humerus Fractures

If proper meticulous technique is used, optimal fracture fixation with avoidance of extensive soft tissue disruption, large incision sizes, and neurovascular injury can be attained.

TWO-PART AND THREE-PART FRACTURES: Open Reduction and Internal Fixation Versus Closed Reduction and Percutaneous Pinning

Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality, comminution, and the deforming forces of the rotator cuff on the tuberosities influence the choice of operative approach and fixation techniques. Closed reductions and percutaneous pinning offer the potential advantage of minimal soft-tissue dissection; however, good bone quality and minimal comminution are prerequisites. Selected two-part surgical neck fractures and valgus-impacted fractures lend themselves well to this technique. Open reduction and internal fixation is indicated in two-part surgical neck fractures with poor bone quality or extensive comminution, two-part greater tuberosity or lesser tuberosity fractures, and most three-part fractures. The choice of surgical approach is dictated by the fracture pattern and includes an extended deltopectoral approach and a superior deltoid-splitting approach. Fixation techniques are myriad and are dependent on the fracture pattern. Potential fixation methods include intramedullary rods, interfragmentary sutures or wires, and extramedullary plates and screws or blade plates. Successful results are predicated on obtaining adequate enough fixation to allow early passive motion. Results also are influenced by the quality of the reduction and patient compliance.

Fixation of Three-Part Proximal Humeral Fractures: A Biomechanical Evaluation

To examine the biomechanical stability of three constructs currently used for the management of three-part proximal humerus fractures. Tension band wires (TBW) with supplemental Enders nails, modified cloverleaf plate and screws, and intramedullary (IM) nailing with proximal and distal interlocks were tested to determine relative stability. A reproducible three-part fracture was made in fresh-frozen stripped proximal humeri. The fracture was stabilized using TBW/Enders nail (n = 6), plate/screws (n = 5), or IM nailing (n = 5). Mechanical testing was performed with a small preload followed by deflection of five millimeters at a rate of one millimeter per second in flexion, extension, and varus and valgus relative to the humeral shaft. A load-displacement curve was obtained. Torsional testing was performed in internal and external rotation, and torque-rotation curves were recorded. In cantilever bending, the plate/screws construct and the IM nail construct were superior to the TBW/Enders nail construct for all parameters except extension. There was no statistically significant difference between the IM nail and the plate/screws groups. Torsional stiffness testing revealed that the plate/screws and the IM nail were superior to the TBW/Enders nail construct. There was no statistical difference between the IM nail and the plate/screws groups. In a cadaveric model of three-part proximal humerus fractures stripped of soft tissue, plate/screws fixation and IM nailing provide greater torsional and bending stiffness than does fixation with TBW/Enders nail. There was no statistically significant difference in torsional or bending stiffness between IM nailing with interlocks and plate/screws fixation in this model.

Closed management and percutaneous fixation of unstable proximal humerus fractures.

In dealing with displaced proximal humerus fractures, there is still much controversy in treatment modalities. The latest investigations emphasize the concept of minimal exposure and rigid fixation. The technique of closed reduction and percutaneous fixation with cannulated screws and k-pins was performed on 19 patients with two- and three-part proximal humerus fractures. The outcomes were evaluated with a mean follow-up of 21 months. All except one case had a solid union of the fracture. Sixteen of 19 patients (84%) acquired good or excellent results according to Neer's classification. No further collapse or avascular necrosis was found. The method of closed reduction and percutaneous fixation, although technically demanding, yields satisfactory results in displaced proximal humerus fracture. Cannulated screws provided rigid fixation that was the underlying tenet for early functional retrieval.