Introduction
The fixation system is a minimally invasive solution for reducible 2-, 3- and 4-part proximal humerus fractures with gentle traction, manipulation and/or percutaneous reduction. It provides for multi-planar, multi-directional (30 degrees) pin placement to maintain stability and passive range of motion throughout the healing process.
The goal is to improve proximal humeral fracture through the system’s advantages:
- Decreased operative time
- Decreased operative blood loss
- Strong and stable fixation with minimal additional soft tissue injury
- Preserved vascularity to tuberosities
- Decreased risk of malunion
- Decreased risk of deep tissue infection in susceptible patients
- Increased stability and range of motion compared to percutaneous pinning
- Multi directional pin placement allows for larger margin of error
- Fast and effective when treating multiple injuries in same OR episode
- No retained hardware
Indications
- Open fractures
- Reducible 2-, 3- and 4-part fractures with minimal traction, manipulation or percutaneous reduction
- Within 2 weeks of fracture to aid reduction
- Medically cleared for operative procedure
Contraindications
- Head splitting fracture
- Irreducible glenohumeral dislocation or fracture pattern
Protocol/Best Practices
- Schedule
- Pin placement within 2 weeks of injury, PROM 1 lb.
- X-rays and clinic evaluation at 7 weeks
- Pin removal at 8 weeks, AROM 5 lbs.
- Follow-up at 3 months (no restrictions) and 6 months
- There is no specific protocol for pin care; daily pin care is advised. In all cases presented here, patients were instructed to cleanse the pins daily with a solution of 50% hydrogen peroxide/50% sterile water
- The pin placement procedure length averaged 40 minutes with a range of 33-45 minutes
- When placing the pins, it is important to have good superior and inferior spread as well as good anterior to posterior spread of the pins for the optimal construct. The multi-planar placement of the pins is critical to provide strength as a construct and reduce the risk of hardware failure
- The pin removal procedure takes 10-15 minutes. Pin removal is performed in the OR setting to optimize pain control, usually with a block and light sedation
- While pin infection is a risk with any procedure, the risk for deep infection may be lower using this external fixation method as opposed to open reduction and internal fixation
Five Case Series
The five-case series presented here demonstrates the value of using the shoulder fixation system on patients with open or reducible 2, 3, and 4-part proximal humeral fractures. The system provides the ability to adjust the pin angle up to 30° for optimal pin placement. Use of this system allows for early passive range of motion throughout the healing process, which, in turn, helps maintain better final active range of motion.
Conclusion
- Low morbidity option
- Short operative time
- Less anesthesia time
- Less bleeding
- Stable fixation
- Little soft tissue disruption