title: Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation - introduction of a new treatment concept.
abstract: The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific discussion. The following study presents the results of a combined procedure using limited invasive fixation techniques for reconstruction of the humerus head and retrograde intramedullary wiring with elastic nails for the treatment of displaced three- or 4-part fractures. A prospective study of 24 patients with 3-part and 4-part fractures was performed from September 1995 to December 1998. Combined biologic fixation for reconstruction of the humerus head, including intramedullary wiring, was utilized. Fracture reduction was performed in an open soft-tissue-preserving technique through a limited lateral approach. Fixation of the head fragments was performed using screw and/or cerclage wire fixation. The reconstructed humerus head was stabilized to the shaft with intramedullary wires, with retrograde insertion 2 cm above the olecranon fossa. Supportive fixation of the head fragments was achieved using fully threaded cancellous screws. At the 1-year postoperative follow-up, 40% of the 18 patients had excellent results using the Neer and Constant score. Forty-five percent had satisfactory and 15% unsatisfactory results. The initial results of this study reveal that a combination of limited internal fixation of the humerus head and retrograde elastic intramedullary wiring provide stable fixation with limited soft-tissue destruction. This approach has been shown to be especially useful for the combined treatment of three- or four-part fractures of the humeral head.
authors.affiliation: Department of Orthopedic Trauma and Reconstructive Surgery, Charité, Humboldt-University of Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. cyrus.khodadadyan@charite.de
authors.forename: Cyrus
authors.initials: C
authors.lastname: Khodadadyan-Klostermann
authors.forename: Michael
authors.initials: M
authors.lastname: Raschke
authors.forename: Roger
authors.initials: R
authors.lastname: Fontes
authors.forename: Ingo
authors.initials: I
authors.lastname: Melcher
authors.forename: Allen
authors.initials: A
authors.lastname: Sossan
authors.forename: Kaushik
authors.initials: K
authors.lastname: Bagchi
authors.forename: Norbert
authors.initials: N
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001864:Bone Wires; D003131:Combined Modality Therapy; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome