INTERNAL-FIXATION OF PROXIMAL HUMERUS FRACTURES USING THE SCREW-TENSION BAND TECHNIQUE

Many of the current techniques of internal fixation of proximal humeru s fractures use tension band wires to achieve secure fixation, allowin g immediate postoperative exercise of the affected limb. In addition, the use of a cancellous lag screw placed from the humeral shaft into t he humeral head may have several advantages. In particular, this lag s crew does not violate the subacromial space and provides initial stabi lity between the head and shaft, which facilitates placement of the te nsion band wires. This technique was used in 13 patients whose average age was 71 years (range 54-86). Follow-up averaged 20 months. Eight p atients had two-part fractures and five patients had three-part fractu res. This technique used a deltopectoral approach with manual impactio n of the humeral head and shaft. A 6.5-mm AO screw was used for lag sc rew fixation in addition to two 18-gauge tension band wires: one place d through the tuberosities and one under the rotator cuff tendons. Pas sive range of motion of the involved shoulder was begun within the fir st postoperative week, and active range of motion and strengthening we re allowed after the fourth postoperative week. At follow-up patients were evaluated for range of motion, function, pain, and radiographic a ppearance of the fracture. Average forward flexion was 160-degrees, ex ternal rotation was 46-degrees internal rotation was to the 10th thora cic vertebra. According to the functional scale proposed by Hawkins, 1 0 of the 13 patients had achieved a good result. Two of the remaining patients had a fair score, and one had a poor outcome. Five of the 13 patients reported occasional, mild pain. Radiographically there was on e instance of slight varus settling. There were no instances of avascu lar necrosis. In one patient, one tension band wire had broken; howeve r, revision was not necessary. Tension band wiring combined with lag s crew fixation afforded sufficient fracture stability to allow early, a ggressive rehabilitation in this elderly patient cohort. As a method o f internal fixation, this technique may have particular advantages in elderly osteoporotic patients.