Pdf management of unstable proximal humeral fractures has remained controversial since ages. It includes the philos percutaneous aiming system, for a less invasive transdeltoid approach. The patients with neurological symptoms in the injured upper extremity were also excluded to avoid. Three part proximal humerus fracture fixation with kwires. Percutaneous fixation of proximal humeral fractures. Treatment for proximal humeral fractures with percutaneous. The name humerus comes from the greek omos, meaning shoulder.
Percutaneous pinning of proximal humerus fractures orthogate. Percutaneous pinning using threaded pins as a treatment option for unstable twoand threepart fractures of the proximal humerus. Clinicoradiological outcome of closed reduction and percutaneous. To evaluate the results after closed reduction and percutaneous fixation of displaced fractures of the proximal humerus with the humerusblock system. Each procedure has some limitations and complications. Certain steps must be taken in order to ensure the success of the fixation. More than this, it is the goal to gently manipulate a strongly displaced fracture to correctly align the fragments among each other and revert the fracture into an only minimally displaced one. The outcomes were evaluated with a mean followup of 21 months.
Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Pdf on jan 1, 2002, seung ju jeon and others published closed reduction and percutaneous fixation in the treatment of proximal humerus fractures find, read and cite all the research you need. Women were affected more than twice as frequently as men. The main goal of percutaneous reduction and fixation of a proximal humerus fracture is not necessarily achieving a perfectly anatomical reduction.
A proximal humerus specific locking plate was implemented. Complex proximal humeral fractures three or four part. Request pdf closed reduction and percutaneous fixation of proximal humerus fractures a technique of percutaneous pinning of proximal humerus fractures had already been described in 1962. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. A technique of percutaneous pinning of proximal humerus fractures had already been described in 1962. Abstract background in dealing with displaced proximal humerus fractures, there is still much controversy in treatment modalities. Approximately 80% of all proximal humeral fractures are treated nonsurgically because they are nondisplaced or minimally. Proximal humeral fractures percutaneous fixation, philos plate, percutaneous kwires. Outcome of open reduction and internal fixation using. The proximal humeral fractures have been treated with a wide range of options, namely nonoperative, open reduction internal fixation, external fixation, closed kwire fixation, percutaneous screw fixation, and tension band fixation. Percutaneous fixation of proximal humerus fractures request pdf. Complications and outcomes of minimally invasive percutaneous.
Philos system is an anatomical lcp plating system for proximal humerus fracture fixation. The latest investigations emphasize the concept of minimal exposure and rigid fixation. The aim of this prospective, multicentric study is. Proximal humerus fracture, percutaneous fixation, neers classification, cannulated screw. Proximal humerus fracture fixation using plate osteosynthesis depends on the quality of the bone, design of the fixation devices and intraoperative soft tissue dissection. Long term results of philos plating and percutaneous k. Percutaneous plating for proximal humeral fractures clinics in orthopedic surgery vol. Untreated 3 and 4part fractures of the proximal humerus have a poor functional outcome.
Percutaneous fixation of proximal humeral fractures ncbi. Percutaneous pinning and nonlocking plate fixation have. Proximal humerus fractures account for 4 to 5% of all. Percutaneous plating can be a good solution to treat some of these fractures using a minimally invasive technique. We hypothesized that this new percutaneous plate would be biomechanically equivalent to this standard.
Twentyseven patients were treated operatively for proximal humeral fracture using the polarus nail. Percutaneous elastic fixation of proximal humeral fractures. Percutaneous pinning an overview sciencedirect topics. The patients were admitted between may 20 to july 2015. Pdf closed reduction and minimally invasive percutaneous. Supracondylar fractures of the humerus pinning technique sagar siddiqui. The technique involved 2 minimal incisions with a lateral deltoid split and a more distal shaft incision. Most of the patients were painfree and the shoulders functioned well despite the severity of shoulder injury. Pdf evaluation of percutaneous pinning in unstable proximal. Closed reduction and percutaneous fixation reduces risk from softtissue dissection and may reduce the fracture indirectly, achieving provisional fixation for anatomic healing. Request pdf percutaneous fixation of proximal humerus fractures closed reduction and percutaneous fixation is a viable treatment option for displaced twopart, threepart, and valgusimpacted.
Complex proximal humeral fracture fixation with philos plate. Outcome of open reduction and internal fixation using plate. Proximal humerus fractures evaluation and management. Wires for treatment of two part proximal humerus fracture kashif rasool1, muhammad zubair2, eid muhammad3, sajid akhtar4 abstract aim. Fixation of a proximal humerus fracture using a polyaxial. Eight of ten proximal humeral fractures are of this type and include all fractures of the proximal humerus, regardless of the level or number of fracture lines, in which no segment is displaced more than 1cm or angulated more than 45.
The age and osteoporotic bone influence treatment options and clinical outcomes. Locked and minimallyinvasive plating is a promising treatment option. Functional loss correlated with tears at the time of injury. Treatment of proximal humerus fractures is controversial and various operative modalities have been tried. To evaluate the safety and functional outcome of a recently described surgical technique of percutaneous plating for proximal humerus fractures. These range from transosseus suture fixation, closed reduction and percutaneous fixation, open reduction and internal fixation with conventional and lockedplate fixation to hemiarthroplasty 1. Although they can occur anytime after birth, their incidence increases progressively with age. Closed reduction and percutaneous fixation of proximal. The remaining 20% present a therapeutic challenge because surgical stabilization is necessary to ensure healing and to optimize function. Multiple treatment options exist for proximal humeral fractures, including nonoperative treatment, 5,6,8 closed reduction and percutaneous pinning crpp, 9,10. There were 18 patients with 12 males and 6 females with the leftsided injury in 10 patients and rightsided in 8 patients. Percutaneous humeral plating of fractures of the proximal hu. Closed reduction and percutaneous pinning of metacarpal fractures. May 27, 2015 the percutaneous approach to proximal humeral fixation emphasizes minimum dissection with the goal of preserving vascularity of the articular segments and thereby decreasing the risk of osteonecrosis.
Proximal humerus fractures current treatment options. Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. The following cases are presented to discuss surgical options in treating proximal humeral fractures with emphasis on locked. Proximal humeral fracture repair and rehabilitation. The most common options for fixation include open reduction and internal fixation with locking plates and intramedullary nailing. The aim of this study was to evaluate the clinical outcome of mippo versus orif via the deltoidpectoralis approach in elderly patients with proximal humeral fractures. Percutaneous plating can be a good solution to treat some of these fractures using a minimally invasive technique and. The percutaneous approach to proximal humeral fixation emphasizes minimum dissection with the goal of preserving vascularity of the articular segments and thereby decreasing the risk of osteonecrosis. Long term results of philos plating and percutaneous kwire. Closed management and percutaneous fixation of unstable. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. There is no consensually accepted recommendation for optimum surgical treatment of unstable fractures of the proximal humerus.
The purpose of this study is to compare the early radiographic results and complications of 2 common methods of internal fixation, percutaneous pinning pp, and flexible intramedullary nailing imn, used to treat these fractures. Percutaneous humeral plating of fractures of the proximal. Closed reduction and percutaneous fixation was first described by bohler2 for the treatment of pediatric proxi mal humerus fractures. Bouquet fixation, or the use of flexible nailing systems, are possible choices but these have been associated with frequent complications. Supracondylar fractures of the humerus pinning technique. Pdf proximal humerus fractures treated by percutaneous. Twopart fractures the twopart fracture includes those proximal humeral fractures with a single displacement. Complex proximal humeral fracture fixation with philos. Open reduction and internal fixation have resulted in. Although orif of proximal humerus fractures may obtain stable fixation and anatomic reduction, significant exposure often is required. To compare the outcome of open reduction and internal fixation orif using plate and closed reduction cr and percutaneous fixation using kwires for treatment of proximal humeral fractures.
Hemiarthroplasty of the proximal humerus is indicated in older patients for the treatment of most fourpart and head split fractures, and selected threepart fractures with moderate comminution and osteoporosis. Warner, md p roximal humerus fractures are common, and about 80% are well managed nonsurgically. Open operation increases the risk of avascular necrosis and. Proximal humerus fractures phfs are exceedingly common and represent the third most common fracture in the elderly. Four part fractures of the neck of the ler7 for adolescent proximal humeral epiphyseal humerus. Proximal humerus fracturedislocation managed by miniopen. Complex proximal humeral fractures three or four part with. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Apr 05, 2016 multiple treatment options exist for proximal humeral fractures, including nonoperative treatment, 5,6,8 closed reduction and percutaneous pinning crpp, 9,10 open reduction and internal fixation. Current treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation orif and mippo through deltoidsplitting approach.
From february 2002 to december 2003, 34 consecutive patients underwent surgery by 5 trauma surgeons from 2 teaching hospitals. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures article in journal of pediatric orthopedics 316. Proximal humerus orif exposure and reduction techniques. Pdf closed reduction and percutaneous fixation in the.
Aim of study is to assess the clinicradiological outcome of percutaneous pinning in proximal humerus fractures. Intramedullary nailing versus percutaneous pin fixation of. Due to the problem of kwire migration which often lead to a loss of reduction, this method of fixation had consequently been less favored. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. A, paoli, pa was established as a standard for comparison11. However, there is a subset of younger male patients who have had higher energy mechanisms. Outcome of percutaneous fixation and locked plates in. Younger patients with an impacted valgus fourpart fracture and good bone quality may be candidates for percutaneous pinning or open. Fractures and injuries of the distal radius and carpus, 2009. Proximal humerus fractures account for 6% of all fractures in. Closed reduction and percutaneous fixation is a viable treatment option for displaced twopart, threepart, and valgusimpacted fourpart proximal humerus fractures. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and nonunions, including open reduction, percutaneous pinning, locking plate and intramedullary nail fixation, and. Methods the technique of closed reduction and percutaneous fixation with cannulated screws and kpins was performed on 19 patients with two and threepart proximal.
Introduction fractures of the proximal humerus are relatively common representing 23 % of all fractures. Use of locked plating in proximal humerus fractures. Proximal humerus fractures the normal humerus the humerus makes up the ball of the ballandsocket shoulder joint. Proximal humerus fracture is the commonest fracture affecting the shoulder girdle in adults and its. We have nowadays many different surgical solutions, ranging from percutaneous pinning to shoulder arthroplasty. Minimal invasive percutaneous plate osteosynthesis mippo. Proximal humeral fractures vary with regard to pattern, degree of comminution, and patient factors such as age, bone quality, and activity level. Better functional results were seen in patients treated with philos plate than those treated with percutaneous kwire fixation.
Internal fixation of proximal humeral fractures using the. Fluoroscopic guided close reduction and percutaneous kwire. Abstract background surgical treatment is often advocated for unstable or severely displaced proximal humerus fractures in older children. Jun 04, 2017 the main goal of percutaneous reduction and fixation of a proximal humerus fracture is not necessarily achieving a perfectly anatomical reduction. Mar 08, 2012 supracondylar fractures of the humerus pinning technique sagar siddiqui. Three part proximal humerus fracture fixation with kwires vs. Fixation with percutaneous kwires may present an efficient treatment option for 2 or 3 part proximal humerus fractures with its advantages of minimal invasiveness and less soft tissue dissection. Methods the technique of closed reduction and percutaneous fixation with cannulated screws and kpins was performed on 19 patients with two and threepart proximal humerus fractures. Percutaneous fixation of proximal humerus fractures sciencedirect. Through a biomechanical comparison of ten different fixation methods for surgical neck fractures of the proximal humerus, the aoasif 5hole tplate synthes u. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. Clinicoradiological outcome of closed reduction and. Percutaneous reduction and external fixation is a reasonable and logical approach to treat complex proximal humeral head fractures, rather than conservative treatment and before hemiarthroplasty by prosthesis is considered. This study evaluates the functional outcome of minimally invasive percutaneous plate osteosynthesis using locking compression plate in proximal humerus.
The stability of percutaneous fixation of proximal humeral fractures article in the journal of bone and joint surgery 92 suppl 2. Percutaneous treatment of proximal humerus fractures peter j. Dash disabilities of the arm, shoulder, and hand and. Percutaneous pinning is a widely used technique that helps to maintain reduction while also having the advantage of being minimally invasive and inexpensive. Fluoroscopic guided close reduction and percutaneous k. Proximal humerus fractures account for 45% of all fractures and are the third most common fracture in the elderly behind fractures of the distal radius and hip horak and nilsson, 1975, baron et al. Percutaneous pinning is possible in almost all fractures of the proximal humerus. The lower or distal part of the humerus makes up the elbow joint with the radius and ulna. The stability of percutaneous fixation of proximal humeral. The aim of the present study was to evaluate functional outcome after open reduction and internal fixation of three part proximal humerus fractures by proximal humerus locking plate compared with k wire fixation. Fractures of the proximal humerus represent 4%5% of all fractures. Percutaneous treatment of proximal humerus fractures.