Radiographic Evaluation of the Consolidation of Humerus Surgical Neck Fractures Treated With Percutaneous Fixation^[*]

Abstract

Objective To evaluate radiographically the postoperative results of patients with fracture of the proximal humerus in two parts of the surgical neck treated with threaded percutaneous fixation.

Methods We evaluated the radiographic results of percutaneous fixation with threaded pins on the treatment of proximal humerus fractures in our service. Preoperative and postoperative images of 42 patients were evaluated, evaluating radiographs until 8 weeks postoperatively. We considered on evaluation the fracture deviation on preoperative images, the loss of reduction and no consolidation.

Results Our consolidation rate was 90.4%, with loss of reduction in 16.6% of the cases and no consolidation rates in just 4 operated cases. We observed a predominance of a specific fracture pattern in the cases with loss of reduction.

Conclusion The present study allows us to consider the percutaneous fixation technique with threaded pins as an alternative in our therapeutic arsenal for the proximal humerus fracture of the surgical neck. Contraindications are considered for low fracture trait on the metaphysis and with medial/lateral cortical impairment.

Keywords

humeral fractures - humeral neck fractures/surgery - fracture fixation internal - radiography

^* Study performed by the Shoulder and Elbow Surgery Group, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brazil

• Referências

• 1 Horak J, Nilsson BE. Epidemiology of fracture of the upper end of the humerus. Clin Orthop Relat Res. 1975;112:250–253. doi: 10.1097/00003086-197510000-00032
• 2 Resch H. Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 2011; 20 (05) 827-832
• 3 Tepass A, Blumenstock G, Weise K, Rolauffs B, Bahrs C. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg 2013; 22 (01) e8-e14
• 4 Resch H, Tauber M, Neviaser RJ. , et al. Classification of proximal humeral fractures based on a pathomorphologic analysis. J Shoulder Elbow Surg 2016; 25 (03) 455-462
• 5 Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 2005; 16 (Suppl. 02) S65-S72
• 6 Gupta AK, Harris JD, Erickson BJ. , et al. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma 2015; 29 (01) 54-59
• 7 Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 1997; 79 (02) 295-300
• 8 Grubhofer F, Wieser K, Meyer DC, Catanzaro S, Schürholz K, Gerber C. Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elbow Surg 2017; 26 (01) 92-100
• 9 Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 2004; 13 (04) 427-433
• 10 Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury 2011; 42 (11) 1283-1288
• 11 Sukthankar AV, Leonello DT, Hertel RW, Ding GS, Sandow MJ. A comprehensive classification of proximal humeral fractures: HGLS system. J Shoulder Elbow Surg 2013; 22 (07) e1-e6
• 12 Ortmaier R, Filzmaier V, Hitzl W. , et al. Comparison between minimally invasive, percutaneous osteosynthesis and locking plate osteosynthesis in 3-and 4-part proximal humerus fractures. BMC Musculoskelet Disord 2015; 16: 297
• 13 Südkamp N, Bayer J, Hepp P. , et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 2009; 91 (06) 1320-1328
• 14 Jaura G, Sikdar J, Singh S. Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly. Malays Orthop J 2014; 8 (01) 4-7
• 15 Matziolis D, Kaeaeb M, Zandi SS, Perka C, Greiner S. Surgical treatment of two-part fractures of the proximal humerus: comparison of fixed-angle plate osteosynthesis and Zifko nails. Injury 2010; 41 (10) 1041-1046
• 16 Seyhan M, Kocaoglu B, Nalbantoglu U, Aydin N, Guven O. Technique of Kirschner wire reduction and fixation of displaced two-part valgus angulated proximal humerus fractures at the surgical neck. J Orthop Trauma 2012; 26 (06) e46-e50
• 17 Magovern B, Ramsey ML. Percutaneous fixation of proximal humerus fractures. Orthop Clin North Am 2008; 39 (04) 405-416 , v
• 18 Carbone S, Moroder P, Arceri V, Postacchini R, Gumina S. The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock device. Int Orthop 2014; 38 (07) 1451-1459
• 19 Moroder P, Tauber M, Carbone S, Auffarth A, Resch H. Modern minimally invasive treatment of proximal humeral fractures. Tech Orthop 2013; 28: 281-286
• 20 Bogner R, Hübner C, Matis N, Auffarth A, Lederer S, Resch H. Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br 2008; 90 (12) 1602-1607