Evaluation of percutaneous pinning in fracture proximal one-third humerus and fracture dislocation

Abstract

Background: Proximal humerus fracture treatment is still an issue with lot of controversies and various treatment modalities had yielded mixed results. Our aim is to study percutaneous K-wires fixation as a modality of treatment, does not need extensive soft tissue dissection, so small fracture fragments & retains periosteal muscle & ligament attachments which held the fracture fragments together. Complications of open reduction are avoided.

Methods: Fractures were classified according to Neer’s Classification system and were treated with closed reduction and K-wire Fixation. They were 16 males and 09 females, with a mean age of 40.5 years. Mean follow-up was of 20.5 months (range 9-24 months). Post-operative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average follow up of 6 months. Mean duration for union was 6.5 (±1.18) weeks. Patients were followed up at 4, 8, 12 weeks and 3, 6, 9 & 12 months interval.

Results: Radiological and functional outcome assessed according to Constant-Murley Shoulder assessment. Complications treated accordingly. Percutaneous K-wire fixation is safe, limited invasive technique and following basic principles of anatomical reduction has excellent results & functional outcome.

Conclusions: We concluded that the soft-tissue bridging of the fracture fragments was crucial for the reduction to benefit from the ligamentotaxis effect. This technique worked well for valgus-impacted or three-part fractures. The rate of osteonecrosis was low, and rehabilitation was easier. Overall, the results from these series are quite encouraging.