Percutaneous Fixation of Proximal Humeral Fractures

The percutaneous approach to proximal humeral fixation emphasizes minimum dissection with the goal of preserving vascularity of the articular segments and thereby decreasing the risk of osteonecrosis.

Perform preoperative imaging to assess fracture displacement and comminution in order to confirm that percutaneous treatment is appropriate.

Attempt closed fracture reduction prior to incision.

Obtain anatomic humeral head reduction, insert terminally threaded pins, and check pin placement fluoroscopically.

Fix the tuberosity fracture(s).

Cut the pins below the skin and irrigate and close the wounds.

Begin passive shoulder motion after pin removal, and initiate active motion at six weeks after pin removal.

The results of this technique in twenty-seven patients with an average age of 58.8 years (range, forty-two to seventy-six years) at the time of injury were reported previously⁶.IndicationsContraindicationsPitfalls & Challenges.