Results of the percutaneous pinning of proximal humerus fractures with a modified palm tree technique

Abstract

Purpose Many techniques are available for closed reduction and percutaneous fixation of proximal humeral fractures. The palm tree technique was described by Kapandji in 1989. In that technique three curved wires are inserted through one hole at the V-shaped insertion of the deltoid muscle. It is a good technique but it has some disadvantages. In this study we introduced some modifications for the technique, and we evaluated the clinical results of the modified technique in treatment of 18 cases. Methods Eighteen patients with displaced proximal humeral fractures were treated by closed reduction and percutaneous fixation with the palm tree technique after minor modifications. The age of the patients ranged from 38 to 75 years with an average of 56 years. Eleven were females and seven were males. The fractures were twopart in 13 cases and three-part fractures in five cases. Results The average time of healing was seven weeks. The follow-up period ranged from 14 months to 39 months with an average of 22 months. The Constant score ranged from 45 to 88 with a mean of 73. The results were satisfactory in 77% and unsatisfactory in 23% of the cases. The complications included pin tract infection in two cases, intraarticular wire migration in one case, skin necrosis around the wires in three cases and malunion with varus deformity in one case. No cases were complicated by neurovascular injury, loss of fixation or avascular necrosis of the humeral head. Conclusions The palm tree technique is a good method for fixation of proximal humeral fractures. It produces good grip in both of the proximal and distal fragments and allows for early joint movements. Our modifications allow for easy insertion of the wires, increase the stability of fixation and minimize the risk of complications.

Incidence and Severity of Infections After Closed Reduction and External Fixation of Proximal Humeral Fractures

“…Previous reports on proximal humerus fractures treated with external fixation found a 6%-19% infection rate. [15][16][17] The 39.1% infection rate in the current study is based on clinical diagnosis with only partial confirmation through positive cultures. These liberal criteria may be responsible for the high rate compared with previous reports.…”

“…The use of percutaneous pinning may or may not involve application of an external fixator. Some surgeons cut the pins short just outside the skin, 17 other surgeons cut the pins and bury them under the skin to prevent pin tract infection, 16 while others use an external fixator device to connect the pins. 15,18 The use of an external fixator was shown to result in fewer cases of pin migration, secondary displacement, and need for reoperation.…”

Kapandji pinning and tuberosities fixation of three- and four-part fractures of the proximal humerus

“…Later, Le Bellec et al [13], reviewing 31 cases treated with the Kapandji method for 19 two-and 12 three-part proximal humerus fractures, reported 26 % of pin migration, increasing to more than 40 % in patients older than 60 years. More recently, El-Alfy [5] proposed to introduce the K-wires into independent holes to avoid the problem of migration. He reported 77 % good or excellent results and only one case of pin migration in a series of 18 cases.…”

“…Few authors are experienced in this technique and have reported the results, including simple and complex fractures [5,13,14,19,28]. The purpose of our study was to evaluate clinical and radiographic outcomes of complex three-or four-part proximal displaced humeral fractures treated with Kapandji pinning and additional fixation of the tuberosities.…”

Proximal Humeral Fractures

“…9,17-20 Insufficient pin number or poor pin placement (ie, convergent) results in minimal fixation and fracture stability. 19,24,25 Infected pin sites require aggressive treatment consisting of pin removal, antibiotics, and deep debridement if not responding immediately. With subchondral pin penetration, the pin has no end-point and can migrate through the bone into the joint.…”