Tension-band wiring supplemented by lag-screw fixation of proximal humerus fractures: a modified technique

Many of the current techniques of internal fixation of proximal humerus fractures employ tension-band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. The addition of a cancellous lag screw placed from the humeral shaft into the humeral head may have several advantages. In particular, this lag screw does not violate the subacromial space and provides for impaction and initial stability between the head and shaft. The technique described herein has been used in 13 patients aged 54 to 86 years with two- and three-part fractures. This technique uses a deltopectoral approach with manual impaction of the humeral head and shaft. A 6.5-mm AO screw is used for lag-screw fixation, and two 18-gauge stainless steel wires are passed beneath the rotator cuff and secured to the shaft distally through drill holes. Passive range of motion of the involved shoulder is begun on postoperative day 1, and active range of motion and strengthening are allowed after the fourth postoperative week. Tension-band wiring combined with lag-screw fixation affords sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation, this technique may have particular advantages in elderly patients with osteoporosis.