External fixation of displaced fractures of the proximal humerus. Technique and preliminary results

Abstract

A new technique for the treatment of displaced fractures of the proximal humerus is described. Twelve fractures in 11 patients were managed by transcutaneous reduction using a Steinmann pin, and external fixation with a Hoffmann-type neutralising bar connected to two half-pins in the humeral head and three half-pins in the shaft. The pins were removed after four weeks. Two patients sustained redisplacement after a further injury, but in the others reduction was maintained. Two cases of pin-track infection resolved after antibiotics, but delayed union resulted. There were no neurovascular injuries and at follow-up of 6 to 12 months no refractures had been seen. The early functional results were excellent or satisfactory in nine cases.

Functional Outcome of Philos Plate Fixation for Proximal Humerus Fractures

“…They include K wire fixation, suture fixation, external fixation, tension band fixation, intramedullary nails and plating. 4,5 The complication rate for different modalities is as high as 50% or even higher. 8,9 Various complications that has been reported are cut-out or back out of the screws and plates, non-union, avascular necrosis, nail migration, rotator cuff impairment and impingement syndrome.…”

“…3 Various treatment modalities are available for the treatment of these fractures, they include K wire fixation, suture fixation, external fixation, tension band fixation, intramedullary nails and plating. 4,5 Philos plate has been developed to improve screw fixation in osteoporotic bone and to minimise soft tissue dissection. 6 This is a precontoured locking compression plate for the proximal humerus.…”

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

“…There are very few reported studies in literature regarding external fixation of displaced proximal humeral fractures [5,[16][17][18][19][20][21][22][23]. Compared with open reduction and osteo-synthesis, external fixation techniques for displaced proximal humeral fractures avoid dissection and stripping of the soft tissues, leads to higher union rates, has a lower incidence of avascular necrosis, prevention of normal scapula humeral relation at its border and speedy rehabilitation [16,17].…”

“…Compared with open reduction and osteo-synthesis, external fixation techniques for displaced proximal humeral fractures avoid dissection and stripping of the soft tissues, leads to higher union rates, has a lower incidence of avascular necrosis, prevention of normal scapula humeral relation at its border and speedy rehabilitation [16,17]. There are however, conflicting reports from different studies regarding use of external fixation as treatment modality for displaced proximal humeral fractures [5,[17][18][19][20][21][22][23]. Many studies in literature reports good or excellent results and less complication compared with open techniques [20][21][22][23], whereas some other studies reports state that external fixation and stabilization of proximal humeral fractures is technically demanding and can be used for two part 2-part proximal humeral fractures.…”

“…There are however, conflicting reports from different studies regarding use of external fixation as treatment modality for displaced proximal humeral fractures [5,[17][18][19][20][21][22][23]. Many studies in literature reports good or excellent results and less complication compared with open techniques [20][21][22][23], whereas some other studies reports state that external fixation and stabilization of proximal humeral fractures is technically demanding and can be used for two part 2-part proximal humeral fractures. External fixation also might lead to acceptance of less than optimal reduction as far as fracture stability is concerned, especially in elderly population with poor bone stock (osteoporosis) [5,[17][18][19].…”