Functional and radiological outcomes of percutaneous wiring for two and three part fractures of the proximal humerus

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-03 DOI:10.1016/j.jcot.2025.103044

Sanjay Sanatkumar Desai , Rachit Vipul Shah , Vishwesh Devendrasinh Chudasama

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引用次数: 0

Abstract

Background

Proximal humerus fractures are common, with minimally displaced types often managed non-surgically. However, displaced fractures present a challenge due to complex patterns and numerous treatment options. While there is a general agreement on managing displaced four-part fractures in the elderly, two- and three-part fractures can be treated using various surgical methods, including open reduction and internal fixation (ORIF) with plate, ORIF with intramedullary nail, external fixation, screw fixation, arthroplasty, and percutaneous wiring. This study aims to evaluate the functional and radiological outcomes of treating two- and three-part proximal humerus fractures using closed percutaneous wire fixation.

Methods

39 patients, with a mean age of 67 years, treated with percutaneous wiring for displaced two and three-part proximal humerus fractures were prospectively evaluated. Radiological evaluation comprised of anteroposterior and axillary radiographs to look for union while functional evaluation was done using the Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scoring systems.

Results

Union was seen in all the cases and 92.3 % patients had satisfactory result with a mean CM score of 72.7 and mean ASES score of 74.2, at an average follow up of 14 months (12–32 months). Three patients (7.69 %) had unsatisfactory results. One patient had malunion secondary to infection. Two patients had low functional scores secondary to systemic illnesses. None of the patients underwent revision surgery.

Conclusion

Percutaneous wiring for displaced two- and three-part fractures of proximal humerus is a reliable, minimally invasive method of fixation. The procedure has predictable outcomes with low complication rate and can be performed under regional block.

Level of Evidence

Level IV; Case series; Treatment Study.

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经皮钢丝治疗肱骨近端二段和三段骨折的功能和放射学结果

背景：肱骨近端骨折很常见，轻度移位型通常非手术治疗。然而，移位性骨折由于其复杂的模式和众多的治疗选择而面临挑战。虽然对于老年人移位的四部分骨折的治疗有普遍的共识，但两部分和三部分骨折可以使用各种手术方法治疗，包括钢板切开复位内固定（ORIF）、ORIF内固定髓内钉、外固定、螺钉固定、关节成形术和经皮钢丝连接。本研究旨在评估采用闭式经皮金属丝固定治疗肱骨近端2段和3段骨折的功能和放射学结果。方法对39例平均年龄67岁的经皮钢丝治疗肱骨近端移位的2、3部分骨折的患者进行前瞻性评价。放射学评估包括正位和腋下x线片以寻找愈合，同时使用Constant-Murley （CM）和美国肩肘协会（ASES）评分系统进行功能评估。结果随访14个月（12 ~ 32个月），CM评分平均为72.7分，as评分平均为74.2分，92.3%患者预后满意。结果不满意3例（7.69%）。1例继发于感染的畸形愈合。2例患者继发于全身性疾病的功能评分较低。所有患者均未接受翻修手术。结论经皮金属丝内固定治疗肱骨近端移位的二、三段骨折是一种可靠的微创固定方法。该手术结果可预测，并发症发生率低，可在局部阻滞下进行。证据等级：IV级；系列;治疗研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.