Internal fixation of proximal humerus fractures using the screw-tension band technique

Many of the current techniques of internal fixation of proximal humerus fractures use tension band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. In addition, the use 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 initial stability between the head and shaft, which facilitates placement of the tension band wires. This technique was used in 13 patients whose average age was 71 years (range 54-86). Follow-up averaged 20 months. Eight patients had two-part fractures and five patients had three-part fractures. This technique used a deltopectoral approach with manual impaction of the humeral head and shaft. A 6.5-mm AO screw was used for lag screw fixation in addition to two 18-gauge tension band wires: one placed through the tuberosities and one under the rotator cuff tendons. Passive range of motion of the involved shoulder was begun with the first postoperative week, and active range of motion and strengthening were allowed after the fourth postoperative week. At follow-up patients were evaluated for range of motion, function, pain, and radiographic appearance of the fracture. Average forward flexion was 160 degrees, external rotation was 46 degrees, and internal rotation was to the 10th thoracic vertebra. According to the functional scale proposed by Hawkins, 10 of the 13 patients had achieved a good result. Two of the remaining patients had a fair score, and one had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)