Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head

Percutaneous reduction and fixation of severe humeral head fractures would be the treatment of choice since it will not increase the risk of necrosis already inherent in these fractures. Nevertheless, the question arises of w hether anatomical reduction is possible with the percutaneous technique and whether the reduced fracture can be adequately stabilized. It is important to study the fracture closely before the operation in order to determine t he fracture type and identify the relationship of the individual fragments to each other. Radiographs taken in at least two planes are essential and a CT scan with 3D reconstruction would be desirable. Besides extraarticular fractures, surgical neck fractures with avulsion of the greater tuberosity (B1 and B2 fractures) and valgus impacted fractures (C1 and C2 fractures) a re good indications for this method due to the fact that in these cases int act connections to rotator cuff tendons or remnants of intact periosteum be tween fragments still exist. Less good indications are fractures with sever e lateral displacement of the articular segment and severely displaced frac ture dislocations (C2 and C3 fractures). From 1990 to 1999, a total of 88 patients with 37 B1 and B2 fractures and 4 1 C1 and C2 fractures were operated on percutaneously. The initial 27 patie nts with 9 BI and B2 and 18 C1 and C2 fractures were followed up. AllB1 and B2 fractures showed good to very good functional results (Constant Score 9 1%). The Constant Score of the C1 and C2 fractures was 87%. The necrosis ra te of the C1 and C2 fractures was 11%. In conclusion, it can be said that the presence of soft tissue bridging of the various fragments is crucial for the reduction to gain benefit from the ligamentotaxis effect. Thus, fractures such as valgus impacted or three-pa rt fractures are very good indications for this technique. It can also be s tated that the necrosis rate is low or at least not increased compared to c ases treated by open reduction. Since the fracture is not exposed, adhesion within the surrounding gliding surfaces is reduced and the rehabilitation period is shorter.