The Journal of Bone and Joint Surgery, Vol 74, Issue 4 508-515, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Percutaneous stabilization of unstable fractures of the humerus
H Jaberg, JJ Warner and RP Jakob
Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
Forty-eight of fifty-four patients who had had closed reduction and
percutaneous pinning of an unstable fracture of the proximal end of the
humerus were available for clinical and roentgenographic follow-up at an
average of three years (range, two to seven years) after the operation.
According to the point-scale of Saillant et al., the result was good or
excellent in thirty-four patients, fair in ten, and poor in four. Four
patients had loss of fixation and had repeat fixation with percutaneous
pinning after a second closed reduction. Only one of them had a poor result
because of malunion. Four patients had a superficial pin-track infection
and loosening of pins, one patient had a deep infection, and two had a
non-union. Complete avascular necrosis with collapse of the humeral head
developed in only two patients. However, eight patients had localized
avascular necrosis with transient cyst formation and sclerosis in the
humeral head that resolved over one to two years; these were thought to
represent subtotal avascular necrosis. Although closed reduction and
percutaneous pinning is a technically demanding procedure, it offered
results in our patients that were comparable with or superior to those
after previously described operative methods for the treatment of unstable
fractures of the proximal end of the humerus.
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