Mini-external fixation of two- and three-part proximal humerus fractures

A retrospective review of 64 patients (M 36, F 28, average age 55 years) with 29 two-part fractures and 35 three-part fractures of the proximal humerus was conducted at a Level 1 Trauma Center. All fractures were managed with the mini external fixator. Open reduction was performed in 11 cases, closed reduction in 53. The average follow-up was 21 months (range, 12-39). The final outcome, evaluated according to Neer's scoring system, was excellent in 63.4% of patients, good in 18.8%, fair in 12.7%, and poor in 5.1%. By 9 weeks, 85% of the fractures were healed and 97% by 12 weeks. Complications included nonunion, superficial infection and deep infection, in two cases for each. Bicipital tendonitis occurred in five cases and secondary displacement of the fragments in four others. The small diameter of the pins used in the mini external fixator has the advantage of allowing the orthopaedic surgeon to fix the fracture in more than one plane and achieve an early acceptable range of motion. This technique appears attractive especially in polytrauma patients, as the procedure can be performed in the supine position and causes no additional blood loss.