Percutaneous Fixation of Proximal Humeral Fractures

INTRODUCTION: 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. STEP 1: PREOPERATIVE PLANNING: Perform preoperative imaging to assess fracture displacement and comminution in order to confirm that percutaneous treatment is appropriate. STEP 2: CLOSED FRACTURE REDUCTION: Attempt closed fracture reduction prior to incision. STEP 3: SURGICAL APPROACH FOR HUMERAL HEAD AND SHAFT REDUCTION: Obtain anatomic humeral head reduction, insert terminally threaded pins, and check pin placement fluoroscopically. STEP 4: TUBEROSITY FRACTURE REDUCTION AND FIXATION OF THE TUBEROSITY FRAGMENTS: Fix the tuberosity fracture(s). STEP 5: WOUND CLOSURE: Cut the pins below the skin and irrigate and close the wounds. STEP 6: POSTOPERATIVE REHABILITATION: Begin passive shoulder motion after pin removal, and initiate active motion at six weeks after pin removal. RESULTS: The results of this technique in twenty-seven patients with an average age of 58.8 years (range, forty-two to seventy-six years) at the time of injury were reported previously(6). Indications Contraindications Pitfalls & Challenges