Abstract
A retrospective study was designed to evaluate the results of closed reduction and percutaneous pinning using threaded pins as a treatment option for fractures of the humeral head. Patients who suffered two- and three-part fractures of the proximal humerus treated by this method of fixation were included. Fifty patients (32 females and 18 males) with an average age of 50 years were clinically evaluated at an average of 2.5 years after this procedure (range 1–4 years). The Constant score was used to evaluate the clinical outcome. Preoperative and postoperative X-rays were also assessed. Out of 50 patients, 18 (36%) obtained excellent results, 17 (34%) good results, eight (16%) fair results and seven (14%) achieved only poor results. The average Constant score was 81 (range 60–100). Fractures confined to the surgical or anatomical neck generally did better than those associated with a greater tuberosity fragment (average score 86 versus 78). Patients who required shaft stabilisation and in addition to reduction and fixation of the greater tuberosity showed a lower average score (68). There were no cases of avascular necrosis, neurovascular complications or deep infections. A significant loss of fracture position due to failure of internal fixation occurred in seven cases, three of these patients underwent revision surgery. Closed reduction and percutaneous pinning offers a good fracture position and stability with minimal soft tissue damage. We recommend that displaced two- and three- part fractures of the humeral head should be treated in this manner. However these patients should be monitored closely for a period of four weeks, since secondary displacement and failure of fixation can occur in this period. Careful patient selection may minimise these complications.
Résumé
Etude retrospective de la réduction à foyer fermé et de la fixation percutanée avec des broches filetées des fractures à deux et trois fragments de l’extrémité supérieure de l’humérus. Method : 50 patients, d’âge moyen 50 ans, ont été évalués cliniquement à un délai moyen de 2,5 ans après l’opération.Le score de Constant ainsi que les radiographies pré et post opératoires ont été utilisés pour l’appréciation. ResultsSur 50 patients 18 obtenaient un excellent résultat, 17 un bon résultat, 8 un résultat moyen et 7 un mauvais résultat. Le score de Constant moyen était de 81 (de 60 à 100). Les fractures isolées du col anatomique ou chirurgical avaient un meilleure évolution que celles associées à une fracture de la grosse tubérosité ( score de 86 au lieu de 78).Les patients qui ont nécessité une réduction et une fixation de la grosse tubérosité en plus de la stabilisation diaphysaire avaient un score moyen plus bas (68). Il n’y avait pas de nécrose, d’infection profonde ni de trouble neurovasculaire. Une perte de réduction est survenu dans 7 cas avec nécessité de reprise chirurgicale 3 fois. Conclusions : la réduction fermée avec fixation par broches percutanées permet une bonne stabilisation de la fracture avec un minimum de dommages aux parties molles. Nous préconisons ce traitement pour les fractures à 2 et 3 fragments de la tête humérale en recommandant une surveillance étroite pendant les 4 premières semaines car le déplacement secondaire et l’échec de la fixation représente un écueil sérieux de la méthode.
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Fenichel, I., Oran, A., Burstein, G. et al. Percutaneous pinning using threaded pins as a treatment option for unstable two- and three-part fractures of the proximal humerus: a retrospective study. International Orthopaedics (SICO 30, 153–157 (2006). https://doi.org/10.1007/s00264-005-0058-7
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DOI: https://doi.org/10.1007/s00264-005-0058-7