Percutaneous osteosynthesis of humeral head fractures.

OBJECTIVE

Reduction and fixation of displaced fractures of the humeral head by percutaneous methods. Early functional postoperative management.

INDICATIONS

Simple subcapital fractures of the humerus, AO 11A2, A3. Multifragmentary fractures of the proximal humerus, AO 11B1, B2, C1, (C2).

CONTRAINDICATIONS

Head split fractures. Fracture dislocations. Severe osteoporosis.

SURGICAL TECHNIQUE

The head fragment, generally impacted in valgus, is lifted by means of an elevator inserted percutaneously. The head is brought into the correct position and fixed to the shaft with two crossed Kirschner wires. The Kirschner wires are clamped into a locking device attached to the lateral cortex of the humerus by one screw to prevent slippage. Displaced tubercles are also reduced percutaneously by the aid of small bone hooks and are stabilized by insertion of cannulated screws.

POSTOPERATIVE MANAGEMENT

Shoulder bandage for 3 weeks. Depending on the stability achieved during operation gentle exercising can be commenced from the 1st postoperative day with the arm bandaged.

RESULTS

200 patients (78 men, 122 women) were followed up at least 2 years (24-81 months) postoperatively. The average age was 61.6 years (14-103 years). The average Constant Score for four-part fractures was 87%. 24% of the patients had to be operated on a second time (shortening of the wires or reosteosyntheses). In 8.5% secondary change of management was necessary. In 3% clinically relevant avascular head necrosis occurred, and pseudarthrosis in 3%.