Percutaneous fixation of proximal humeral fractures

The purpose of the current study is to evaluate the technique of closed red uction and percutaneous pinning of proximal humeral fractures and to determ ine whether this technique provides enough stability to permit early active range of motion and subsequent fracture healing. Fractures were classified according to Neer et al and were included if the surgical or anatomic neck were angulated greater than 45 degrees, separation between fragments was g reater than 1 cm, or the greater tuberosity was displaced more than 0.5 cm. There were 21 Type II, 16 Type III, and four Type IV fractures. Fractures were pinned using distally threaded Dynamic Hip Screw(R) guide pins, 2-mm K irschner wires, or 2.5-mm distally threaded Schantz(R) pins. Patients were evaluated for union rates and motion. Assessment was made using the Modifie d American Shoulder and Elbow Surgeons Form. Thirty-six patients with 37 fr actures were available for review with followup averaging 40 months (range, 12-68 months). All patients with Neer Type IV fractures did not respond to fixation and three had avascular necrosis develop, irrespective of the typ e of pin used. In the remaining 33 patients with Neer Type II and Type III fractures, a union rate of 94% was observed at an average of 2.6 months. Al l patients had good functional results. In the current series, there were n o failures using Schantz(R) pins. There was a 20% failure rate with Dynamic Hip Screw(R) pins (2% if the patients with Type IV fractures were excluded ) and a 100% failure rate with Kirschner wires. Stable fixation with early motion and subsequently good results can be obtained using percutaneous fix ation in patients with Type II and Type III fractures; however, terminally threaded pins must be used and smooth Kirschner wires must be avoided. Perc utaneous fixation cannot be recommended in patients with Type IV fractures.