مرکز منطقه ای اطلاع رساني علوم و فناوري - The importance of patient selection for the treatment of proximal humerus fractures with percutaneous technique

Latin Abstract :

Objectives: We evaluated the indications and disadvantages of percutaneous technique for proximal humerus fractures in relation to complications encountered in osteoporotic elderly patients and the importance of patient selection. Methods: The study included 18 patients (10 men, 8 women; mean age 48 years; range 14 to 89 years) who underwent per¬cutaneous fixation (closed reduction and pin fixation with K- wires or Schanz screws) for proximal humerus fractures. Eight patients were beyond 60 years of age. According to the Neer classification, five patients had two-part, 13 patients had three- part neck fractures. The patients were evaluated with range of motion of the shoulder, radiographs, and the Disability of Arm Shoulder and Hand questionnaire (DASH). The mean follow- up was 23 months (range 8 to 60 months). Results: The mean shoulder abduction was 134° (range 30° to 160°) and the mean elevation was 118° (range 30° to 140°). Full range of motion of the shoulder was achieved in 11 patients (61.1%), including all with two-part fractures. Abduction losses of 60° to 130° and less than 30° were seen in four patients and three patients, respectively, all of whom were older than 60 years. The mean DASH score was 18 (range 0 to 77). Fourteen patients having a score of less than 10 had no pain or func¬tional complaints. Four patients with a score of more than 10 were older than 70 years. Pin migration was observed in seven patients (38.9%), all of whom were over 60 years of age. One patient required revision with partial prosthesis. Nonunion was seen in one patient (5.6%) and malunion with a varus/valgus deformity occurred in four patients (22.2%). None of the pa¬tients developed avascular necrosis. Conclusion: Percutaneous fixation may be preferred in the treatment of two-part and carefully-selected three-part proxi¬mal humerus fractures. Due to high complication rate, patient selection is of primary importance among elderly patients.