Summary

Proximal humerus fractures are common injuries and there are many ways of treating the various fracture patterns including alternative, less invasive methods like the percutaneous method we describe in this study, which yield the same or even better results than the more widely used fixation methods

Abstract

Introduction

The proximal humerus makes up 4 – 6% of all the fractures presenting to Orthopaedic services and is therefore, a common injury. It’s incidence is on the rise, especially in the elderly cohort. There are many ways of treating the various fracture patterns The objective of our study is to explore alternative, less invasive methods for proximal humerus fixation which yield the same or even better results than the more widely used fixation methods. In this case review we looked at the percutaneous fixation method.

Method

This was a retrospective review of a single-centre cohort of patients operated on by the senior author between 2010 and 2020. This method of fixation was only indicated in specific fracture patterns i.e. Surgical neck +/- GT fractures, 2 or 3 part fractures, non-head splitting fractures, neutral/valgus impacted fractures. We used 2 types fixation devices: 2 – 4 large calibre (2mm) K-wires and a suture anchor device (Q-fix). We observed the fracture healing time, complications and time to return to pre-operative functionality level, using the Oxford Shoulder Score (OSS). We followed up these patients at 2 weeks, 4 weeks and 3 months post op. We then compared outcomes for similar fracture patterns managed with open reduction and internal fixation (ORIF), using the Philos plating system.

Results

This method of percutaneous fixation was used in 19 patients within this time period. There were a total of 16 patients included in the final analysis. Male-to-female ratio was 1:2, with an average age of 57 (range 14 – 80) years old. There were 2 complications, 1 pin site infection and 1 K-wire migration, both were managed with removal of wires with no further issues. There were no complications like calcar collapse. The post-operative pain reported was much less than when compared with the ORIF technique. The Oxford Shoulder Score following the percutaneous method showed a mean score 40/48 (range 34 – 40) compared to 41/48 (range 17 – 48) for the ORIF group. This is an extremely positive outcome with no statistically significant difference between the 2 groups.

Conclusion

This study, which is still ongoing, explains our positive experience with percutaneous proximal humerus fixation, and sheds some light on an alternative fixation method which can offer less severe complications as compared to other methods. We are encouraged to continue with the technique and to collect further data with a longer term follow up and hopefully compare outcomes more directly with other fixation methods