The hybrid technique: potential reduction in complications related to pins mobilization in the treatment of proximal humeral fractures.
BACKGROUND
Proximal humeral fracture fixation has a high incidence of complications especially when pins are used in elderly patients. In 2005, we introduced a new technique that augmented osteosutures by using 2.5-mm fully threaded pins and an external fixator (hybrid technique). The purpose of this study is to compare the outcomes of the hybrid technique (HT) with traditional pins fixation.


METHODS
A prospective nonrandomized study was organized on 2 consecutive series of patients: 51 patients treated with percutaneous fixation using 2.5-mm terminally threaded pins and 55 patients treated with the Hybrid technique. In both groups, an open reduction and osteosutures augmented with percutaneous fixation was used when closed reduction was insufficient to provide anatomical reduction. The patients were assessed at 6- and 12-month follows-ups using DASH score, Constant score, and Modified Constant score (MCS).


RESULTS
Sixteen patients treated with traditional pins experienced complications compared to 6 patients in the HT group (P = .006). The revision rate was 19% for the traditional pins group and 4% for the HT group (P = .04). Pins migration affected 8 patients in the traditional pins group and 1 case in the hybrid group (P = .01). The MCS at the 12-month follow-up was 89 ± 9 in the HT group and 77 ± 14 in the traditional pins group (P = .03). The MCS was negatively affected by complications and malreduction (P = .001).


CONCLUSIONS
The study suggests that the HT is a valuable option for the treatment of proximal humeral fractures. It has benefits compared to the traditional technique.
Blonna
Davide
D
University of Turin Medical School, Umberto I Mauriziano Hospital, Torino, Italy. davide.blonna@virgilio.it
Castoldi
Filippo
F
Scelsi
Michele
M
Rossi
Roberto
R
Falcone
Giuseppe
G
Assom
Marco
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome