Desai Sanjay Sanatkumar, Shah Rachit Vipul, Chudasama Vishwesh Devendrasinh
Breach Candy Hospital Trust, 60 A, Bhulabhai Desai Road, Mumbai, Maharashtra, 400 026, India.
Bhatia Hospital, Tardeo Road, Mumbai, Maharashtra, 400 007, India.
J Clin Orthop Trauma. 2025 May 3;67:103044. doi: 10.1016/j.jcot.2025.103044. eCollection 2025 Aug.
Proximal humerus fractures are common, with minimally displaced types often managed non-surgically. However, displaced fractures present a challenge due to complex patterns and numerous treatment options. While there is a general agreement on managing displaced four-part fractures in the elderly, two- and three-part fractures can be treated using various surgical methods, including open reduction and internal fixation (ORIF) with plate, ORIF with intramedullary nail, external fixation, screw fixation, arthroplasty, and percutaneous wiring. This study aims to evaluate the functional and radiological outcomes of treating two- and three-part proximal humerus fractures using closed percutaneous wire fixation.
39 patients, with a mean age of 67 years, treated with percutaneous wiring for displaced two and three-part proximal humerus fractures were prospectively evaluated. Radiological evaluation comprised of anteroposterior and axillary radiographs to look for union while functional evaluation was done using the Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scoring systems.
Union was seen in all the cases and 92.3 % patients had satisfactory result with a mean CM score of 72.7 and mean ASES score of 74.2, at an average follow up of 14 months (12-32 months). Three patients (7.69 %) had unsatisfactory results. One patient had malunion secondary to infection. Two patients had low functional scores secondary to systemic illnesses. None of the patients underwent revision surgery.
Percutaneous wiring for displaced two- and three-part fractures of proximal humerus is a reliable, minimally invasive method of fixation. The procedure has predictable outcomes with low complication rate and can be performed under regional block.
Level IV; Case series; Treatment Study.
肱骨近端骨折很常见，轻度移位的骨折类型通常采用非手术治疗。然而，移位骨折由于其复杂的骨折模式和众多的治疗选择而具有挑战性。虽然对于老年移位四部分骨折的治疗已达成普遍共识，但两部分和三部分骨折可采用多种手术方法治疗，包括钢板切开复位内固定（ORIF）、髓内钉ORIF、外固定、螺钉固定、关节成形术和经皮穿针固定。本研究旨在评估采用闭合经皮穿针固定治疗两部分和三部分肱骨近端骨折的功能和影像学结果。
对39例平均年龄67岁、采用经皮穿针治疗移位两部分和三部分肱骨近端骨折的患者进行前瞻性评估。影像学评估包括前后位和腋位X线片以观察骨折愈合情况，而功能评估则使用Constant-Murley（CM）和美国肩肘协会（ASES）评分系统进行。
所有病例均实现骨折愈合，92.3%的患者结果满意，平均CM评分为72.7，平均ASES评分为74.2，平均随访14个月（12 - 32个月）。3例患者（7.69%）结果不满意。1例患者因感染导致畸形愈合。2例患者因全身性疾病导致功能评分较低。所有患者均未接受翻修手术。
经皮穿针治疗移位的肱骨近端两部分和三部分骨折是一种可靠的微创固定方法。该手术具有可预测的结果，并发症发生率低，且可在区域阻滞下进行。
IV级；病例系列；治疗研究。
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