title: Modification of the Resch procedure: a new technique and its results in managing three- and four-part proximal humeral fractures.
abstract: Controversy surrounds the management of displaced   three- and four-part fractures of the proximal humerus. The percutaneous   Resch technique of stabilisation involves minimal soft-tissue dissection   and a reduced risk of stiffness and avascular necrosis. However,   it requires a second operation to remove Kirschner wires and the   humeral block. We describe a modification of this technique that   dispenses with the need for this second operation and relies on   a sequential pattern of screw placement. We report the outcome of   32 three- or four-part fractures of the proximal humerus treated   in this way at a mean follow-up of 3.8 years (2 to 8)). There were   14 men and 18 women with a mean age of 56 years (28 to 83). At final   follow-up the mean Oxford shoulder scores were 38 (31 to 44) and   39 (31 to 42), and the mean Constant scores were 79 (65 to 92) and   72 (70 to 80) for three- and four-part fractures, respectively. We   further analysed the results in patients aged < 60 years with   high-energy fractures and those aged ≥ 60 years with osteoporotic   fractures. There were no cases of nonunion or avascular necrosis. The results were good and comparable to those previously reported   for the Resch technique and other means of fixation for proximal   humeral fractures. We would recommend this modification of the technique   for the treatment of displaced three-part and four-part fractures   in patients both younger and older than 60 years of age.
authors.affiliation: University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
authors.forename: V I
authors.initials: VI
authors.lastname: Roberts
authors.forename: B
authors.initials: B
authors.lastname: Komarasamy
authors.forename: R
authors.initials: R
authors.lastname: Pandey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012784:Shoulder Fractures / Q000601:surgery*