Functional and radiological evaluations of unstable displaced proximal humeral fractures treated with closed reduction and percutaneous pinning fixation.

Objective: The purpose of this study is to evaluate the functional and radiological outcomes of patients with unstable displaced proximal humeral fractures treated with closed reduction and percutaneous pinning (CRPP) fixation.

Methods: We retrospectively reviewed 87 cases of displaced (2-, 3- or 4-part fractures according to Neer classification) proximal humeral fractures treated with CRPP fixation in our center from September 2003 to September 2008. Sixty-four patients were followed up for a period ranging from 12 to 48 months (averaging 16.2 months) and evaluated for the functional and radiological outcomes by a series of standard questionnaire and measurement.

Results: The fractures in all 64 patients were healed with an average time of 15.4 weeks (ranging from 12 to 43 weeks), and the mean interval between the operation and full functional exercise was 17.3 weeks (ranging from 14 to 38 weeks). At the final follow-up visit, no patients showed shoulder instability; the mean range of abduction motion was 157.1° (ranging from 70 to 180°). For all patients, no statistically significant difference in the functional outcomes was observed between their 6-month and final follow-up visits, nor in the radiological findings between their immediately postoperative and fi- nal follow-up examinations.

Conclusion: CRPP fixation is a feasible treatment option for unstable displaced proximal humeral fractures, especially for 2- and 3-part fractures in elderly patients. Although technically demanding, it offers reliable stability without extensive soft tissue dissection, allowing the early painless range of motion. This technique could also promote bone healing, prevent ischemic osteonecrosis of the head of humerus and lead to few complications.