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[Treatment of two-part proximal humeral fracture with closed or mini-open assisted reduction and percutaneous pinning].

OBJECTIVE
To discuss the therapeutic effects of closed or mini-open assisted reduction and percutaneous pinning for the treatment of two-part proximal humeral fracture.


METHODS
Twenty-eight patients with two-part proximal humeral fractures were treated with closed or mini-open assisted reduction and percutaneous pinning from November 2005 to November 2006. There were 12 males and 16 females. The mean age was 54.7 years, ranging from 31 to 73 years. The two-part proximal humeral fractures of 28 patients were all fresh fractures. According to Neer classification, there were 18 patients with two-part surgical neck fractures and 10 patients with impacted valgus two-part greater tuberosity fractures.


RESULTS
The average operation time was 42 minutes and the wound healed at the primary stage. The X-ray showed all fracture had good reduction with almost no anterior angulation. The average neck shaft angle was changed from 175 (ranged, 160 degrees to 200 degrees) preoperatively to 136 degrees (ranged, 128 degrees to 142 degrees) postoperatively, and the displacement of greater tuberosity was reduced to less than 3 mm postoperatively in impacted valgus two-part greater tuberosity fracture group. The average clinical follow-up time was 10.3 months (ranged, 6 to 13 months). All fractures healed and had no avascular necrosis of the humeral head. The wires were removed 8 to 10 weeks post-op. According to the shoulder score of Constant-Murley and ASES,the mean ASES score was 91.2 points (ranged, 63 to 100 points) and Constant-Murley score was 90.4 points (ranged, 67 to 100 points). After the treatment, 12 cases got an excellent result, 14 good and 2 moderate.


CONCLUSION
Closed or mini-open assisted reduction and percutaneous pinning is not as easy as it looks and must be applied with fluoroscopy. But it is the effective method for managing the certain types of proximal humeral fracture with the advantage of less injury and faster recovery. The bone condition of proximal humerus is the key factor to the stability of fixation.