title: Percutaneous pinning using threaded pins as a treatment option for unstable two- and three-part fractures of the proximal humerus: a retrospective study.
abstract: A retrospective study was designed to evaluate the results of closed reduction and percutaneous pinning using threaded pins as a treatment option for fractures of the humeral head. Patients who suffered two- and three-part fractures of the proximal humerus treated by this method of fixation were included. Fifty patients (32 females and 18 males) with an average age of 50 years were clinically evaluated at an average of 2.5 years after this procedure (range 1-4 years). The Constant score was used to evaluate the clinical outcome. Preoperative and postoperative X-rays were also assessed. Out of 50 patients, 18 (36%) obtained excellent results, 17 (34%) good results, eight (16%) fair results and seven (14%) achieved only poor results. The average Constant score was 81 (range 60-100). Fractures confined to the surgical or anatomical neck generally did better than those associated with a greater tuberosity fragment (average score 86 versus 78). Patients who required shaft stabilisation and in addition to reduction and fixation of the greater tuberosity showed a lower average score (68). There were no cases of avascular necrosis, neurovascular complications or deep infections. A significant loss of fracture position due to failure of internal fixation occurred in seven cases, three of these patients underwent revision surgery. Closed reduction and percutaneous pinning offers a good fracture position and stability with minimal soft tissue damage. We recommend that displaced two- and three- part fractures of the humeral head should be treated in this manner. However these patients should be monitored closely for a period of four weeks, since secondary displacement and failure of fixation can occur in this period. Careful patient selection may minimise these complications.
authors.affiliation: Orthopaedic Department, Tel Hashomer Hospital, Ramat-Gan, Israel. itay-f@smile.net.il
authors.forename: Itay
authors.initials: I
authors.lastname: Fenichel
authors.forename: Ariel
authors.initials: A
authors.lastname: Oran
authors.forename: Gideon
authors.initials: G
authors.lastname: Burstein
authors.forename: Moshe
authors.initials: M
authors.lastname: Perry Pritsch
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D006811:Humerus / Q000473:pathology*; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome