Proximal humerus fractures treated with a modified palm tree technique

Several surgical techniques have been used for shoulder fracture treatment. In 1989, Kapandji described the 'Palm Tree technique' for the first time, consisting of inserting three K-bent wires through a bone hole created under deltoid muscle insertion. The purpose of this study was to evaluate clinical and radiographic results of proximal humerus fractures treated by a modified "palm tree technique."

From August 2021 to March 2025, 43 patients with proximal humerus fractures underwent surgical treatment using the modified Palm Tree technique. The mean age was 61.8 years (range, 17-85 years), with a mean follow-up of 17.4 months (range, 6-24 months). According to the Neer classification, two-part, three-part, and four-part fractures were treated by this technique, all performed by the same surgeon. Clinical outcomes were assessed using the Constant Score, UCLA Shoulder Rating Scale, and DASH scores.

A total of 43 patients were included in the final analysis. The mean Constant Score was 79.3 ± 25.4, the mean UCLA score was 27.3 ± 10.0, and the mean DASH score was 18.5 ± 25.9. Six cases (14.0%) of K-wire migrations were encountered whereas two cases (4.7%) of avascular necrosis of the head required shoulder arthroplasty. One patient developed non-union (2.3%) and another secondary loss of reduction. No neurovascular injury or fracture at the entry site has been reported.

The modified Palm Tree technique appears to represent a feasible, joint-preserving, minimally invasive treatment option for selected proximal humeral fractures, providing favorable functional and radiographic outcomes. Careful patient selection remains essential, particularly in elderly patients with poor bone quality.