Displaced subcapital fractures of the humerus represent a therapeutic challenge for the surgeon, all the more so because of their high incidence among osteoporotic patients. Open surgical repair involves increased risk of avascular necrosis of the humeral head, while percutaneous reduction and fixation often fails as a result of loosening pins. As a possible solution, a minimally invasive technique was developed in which a dynamic titanium wire helix is inserted into the medullary space of the diaphysis of the humerus and then rotated proximally into the head fragment. This new approach for osteosynthesis was performed in 84 patients, most of whom had suffered two- or three-part fractures. Results were evaluated by the Constant Functional Score, indicating an average 87% rehabilitation. An associated anatomical study of 53 human cadavers investigated the position of the main branches of the axillary nerve relative to the surgical placement of the wire helix. In all cases, the distance between the most vulnerable anterior branch of the axillary nerve (ABAN) and the operative site was sufficient, as long as insertion occurs in the distal third of the distance between the head of the humerus and the deltoid tuberosity. Utilization of the titanium helix results in prompt healing of subcapital fractures while offering minimal risk for the elderly osteoporotic patient and does not endanger branches of the axillary nerve.

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We report retrospective analysis of results of conservative and operative methods of distal radial fractures, which was carried out to control our treatment methods. Three hundred and ninety-three patients were treated from 1. 7. 1991 to 1. 7. 1992, 361 (91.9%) were followed up to 14 months with average age of 60.1 years (16 to 92 years). Three hundred and twenty-seven patients (90.6%) were treated by conservative methods, 9 (2.5%) by percutaneous pinning, 21 (5.8%) by transfixation through bases of metacarpal bones and 4 (1.1%) by ventral supporting plates. Clinical examination showed 69.6% good, 24.9% fair and 5.5% poor results. Radiological results according to AO-scheme were compared with clinical results, and 70% clinical results correlated with radiological results. Our results show that comminuted and displaced intraarticular fractures AO-classification C 2, C 3 are indications of transfixation and A 3 and some exceptional cases of C 1 are indications of percutaneous pinning.

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