Percutaneous fixation of displaced proximal humeral fractures: Indications based on the correlation between clinical and radiographic results

Calvo, Emílio; Miguel, Ignacio de; Cruz, Juan; López-Martín, N.

doi:10.1016/j.jse.2007.03.019

Cited by 66 publications

(56 citation statements)

References 25 publications

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“…All patients had informed and written consent obtained for the purpose of the study. The patients were informed about the benefits of external fixation and stabilization which included less invasiveness of the surgical procedure, minimal or less soft tissue dissection and almost no soft tissue stripping and the possible complications of external fixation which included loss of fracture reduction requiring more extensive surgery, pins migration and pin-tract infection; discomfort due to external fixator during the course of treatment [5,8,[16][17][18][19][20][21][22][23]. The present study was approved by ethical committee of institution.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, conservative management of displaced fractures of proximal humerus often results in mal union and poor shoulder function. In this subset of individuals surgical treatment is recommended [5]. The widely accepted treatment of severely comminuted intra-articular proximal humeral fractures is hemi-arthroplasty or total shoulder arthroplasty [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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]. In our study we aimed to analyse the results of closed reduction and external fixation for displaced three or four part fractures involving humeral head and associated with dislocated humeral head.…”

Section: Introductionmentioning

confidence: 99%

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

Nikose¹

2016

MOJOR

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Background: The complex fractures of the proximal humerus remain dilemmas far as treatment is concerned. Although better-quality techniques of internal fixation and prosthetic replacement are introduced effectively in the field of operative fracture care, management of complex fractures of the proximal humerus for head preserving modalities in injuries involving the humeral head remains to be a major factor concerning the trauma surgeon. Materials & Methods:Thirty nine patients with complex three or four part proximal fracture of humerus with dislocation of humeral head were treated and analyzed for results of percutaneous reduction and external fixation. All Patients were subjected to careful closed reduction under general anesthesia with optimal relaxation and fluoroscopic control followed by percutaneous external fixation of proximal humerus in optimal position. The patients were evaluated clinically and radiologically for a period till union or 10 months, whichever was earlier.One patient had an incomplete brachial plexus injury, which was yet to recover completely at the end of last follow up 10 months, with acceptable hand, elbow and shoulder function.Results: Percutaneous reduction & external fixation to treat complex fractures of the proximal humerus produces good results, if correct re-position and biological principles are respected. Most of the patients were pain-free and the shoulders functioned well despite the severity of shoulder injury. Conclusions:Percutaneous reduction and external fixation is a reasonable and logical approach to treat complex proximal humeral head fractures, rather than conservative treatment and before hemi-arthroplasty by prosthesis is considered, in view of the acceptable results obtained. Our study shows that complex fractures of the proximal humerus should be treated initially by head preserving procedures. The probable revascularization of the humeral head occurs by creeping substitution as the shoulder is non weight bearing joint.

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