Percutaneous fixation of valgus displaced fracture of the proximal humerus using a single screw

Percutaneous Pinning for Proximal Humerus Fractures: Insights From a Five-Year Retrospective Study

INTRODUCTION

Proximal humerus fractures are a common orthopedic challenge, particularly in older adults. Percutaneous pinning, a minimally invasive technique, aims to stabilize fractures while preserving soft tissue integrity. This study evaluates the functional and radiological outcomes of patients treated with percutaneous pinning at a single center over five years.

METHODS

A retrospective review was conducted of patients who underwent percutaneous pinning for proximal humerus fractures between 2018 and 2023. Of 15 identified patients, 13 met the inclusion criteria of completing at least a three-month follow-up. Data were extracted from clinical records and radiological assessments, focusing on demographics, fracture characteristics, surgical details, complications, and functional outcomes.

RESULTS

The study included 13 patients, of whom 12 (92%) were female, with a mean age of 60 years (range: 12-73 years). Most fractures (12/13, 92%) were three-part injuries resulting from low-energy trauma (11/13, 85%). All procedures were performed by a consultant shoulder specialist, using a combination of two to three K-wires with suture anchors. Anatomical alignment was achieved postoperatively in 10 (77%) cases, and radiological healing was observed in 10 (77%) by four weeks. At final follow-up, 12 (92%) patients demonstrated either excellent (9/13, 69%) or good alignment (3/13, 23%). Functionally, 11 (85%) patients reported either no pain (9/13, 69%) or mild pain (2/13, 15%). Similarly, 11 (85%) achieved either full functionality (8/13, 62%) or functionality with mild limitations (3/13, 23%) in arm use, with eight (62%) demonstrating a good range of motion. Complications were minimal, with no adverse events in nine (69%) cases. Early pin loosening occurred in three (23%) patients, and one (8%) required wire removal due to significant displacement. Follow-up duration ranged from three to 15 months (mean: 7.5 months), with patients attending an average of five clinic visits.

CONCLUSION

Percutaneous pinning provides reliable outcomes for selected proximal humerus fractures, yielding high rates of functional recovery and favorable radiological results. The use of suture anchors is particularly important for stabilizing the greater tuberosity and ensuring calcar support. With most patients experiencing satisfactory pain relief, functional use, and alignment, this minimally invasive approach demonstrates its efficacy and safety.

Clinical outcomes of a novel 'all-suture' fixation for valgus-impacted proximal humeral fractures

Background

Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty and reverse shoulder replacement. Valgus-impacted fractures are a common subtype of proximal humeral fracture, but there are few publications concerning the outcomes of treatment. This study aims to review outcomes following an 'all-suture' technique for this fracture subtype without the use of transosseous sutures.

Methods

All patients over the age of 18 who presented with 3- or 4-part valgus-impacted proximal humeral fractures and who underwent 'all-suture' repair at our centre were included. We reviewed their post-operative imaging and collected data on post-operative complications and patient-reported outcome measures.

Results

We identified 15 patients who had undergone all-suture fixation. The cohort's mean age was 56. Eleven patients were female. Eight patients had 3-part fractures and seven patients had 4-part fractures. There were no major post-operative complications. All fractures united. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at the final follow-up.

Discussion

Our results suggest that all-suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation.