"Suspension bridge" external fixation technique for the treatment of proximal humeral fractures

Radiological and Functional Outcomes of Joshi External Stabilization System (JESS) in Proximal Humerus Fractures: A Retrospective Review

Introduction

There has been an increased interest in the external and percutaneous fixation of proximal humerus fractures. Numerous advantages of external fixation like less blood loss, ease of application, and rigid fixation provide a promising new avenue for the management of humeral fractures. This retrospective case series aims to assess the radiological and functional outcome of proximal humerus fractures treated with the Joshi External Stabilization system (JESS).

Materials and Methods

A retrospective review of records was performed using hospital records from January 2020 to January 2024. The records of patients more than 18 years of age with proximal humerus fractures who were operated with the JESS fixator were reviewed and a proforma based on each follow-up was filled by the investigators.

Results

A total of 28 patients met the inclusion criteria with an average age of 65.17 ± 13.1 years. Neers type 3 injuries were most common (38.3%, n = 11). All fractures united on 6-week follow-up. 75% (n = 21) reported good 25% (n = 7) excellent Constant scores at 24 weeks. The overall complication rate was 28.6%. Common complications were superficial pin tract infections and fixator loosening.

Conclusion

The JESS is an acceptable treatment option for orthopaedic surgeons for the fixation of proximal humeral fractures, especially in geriatric patients. Like other external fixation devices, pin tract infection and pin loosening are inherent to the system.

Does minimally invasive external fixation of proximal humerus fractures provide adequate stability? A biomechanical in vitro study

INTRODUCTION

Proximal humerus fractures are usually treated with rigid angle-stable plates or nails. As an alternative, semi-rigid, minimally invasive systems have been developed for supportive fixation. A new system uses this principle with 2.5 mm partially threaded pins and external fixation.

AIM

This study aimed to compare the fracture stability of the fixator with an angular stable plate about whether the mechanical stability is sufficient for early postoperative mobilisation.

MATERIALS AND METHODS

Human proximal humeri (paired, female, age ≥ 60, n = 8) were cut to a 3-part fracture and treated with an external fixator (Galaxy Shoulder, Orthofix) or an angular stable plate (Philos, DePuy Synthes). A physiological load was simulated in vitro based on a 45° abduction motion. The load level was continuously increased from 10 to 320 N within 10,000 cycles simulating the loads during rehabilitation. This was followed by another 10,000 cycles at 320 N for fatigue testing. Fracture motion was recorded with a 3D camera. Fracture stability was evaluated at a partial load of 160 N and 240 N (simulating loads during early mobilisation).

RESULTS

The fracture motion at the lateral aspect was significantly (p < 0.034) larger for the fixator compared to the plate both for axial and for shear movements, while at the medial aspects fracture motions were similar. Both fixation systems adequately stabilized the lateral tubercle fragment with no significant differences between fixation techniques. The migration of the fixator pins (1.1 ± 1.0 mm) and valgus rotation of the head fragment were minimal (3.1 ± 2.0°). The maximum load level of 320 N was reached by all plate constructs and 3 fixator constructs.

CONCLUSION

Our results suggest that the external fixator system allows early but gentle postoperative mobilisation. More aggressive rehabilitation measures should be postponed after the healing of the fracture.