ELASTIC INTRAMEDULLARY OSTEOSYNTHESIS OF PROXIMAL HUMERAL FRACTURES IN THE ELDERLY – HELIX WIRE TECHNIQUE

Abstract

Introduction: Proximal humeral fractures have been increasing in recent years with the increase in population over 60 years old.

20 to 30% of these fractures require surgical treatment according to the Neer criteria: fragments dislocation greater than 1 cm and/or an angle greater than 45°.

A rigid fixation of proximal humeral fractures in elderly patients with osteoporotic bone is not satisfactory; new solutions are sought.

The authors describe a minimally invasive technique that uses an intramedullary elastic implant – helix wire.

Objective: Evaluate functional outcomes and complication rates in patients with humeral subcapital fractures who underwent fixation with helix wire.

Material: Cross-sectional study evaluating patients with subcapital fracture of the humerus who underwent fixation with helix wire.

Methods: There were operated 32 patients with proximal humeral fractures with helix wire implant, with an average age of 71 years old (41–90). 9 men and 23 women.

According to Neer’s classification: 18 two parts fractures, 12 three parts and 2 four parts.

Osteosynthesis with cannulated screws was associated to the helix wire in three and four parts fractures.

In all patients the shoulder was immobilized for 3 weeks. After 3 weeks patients started rehabilitation.

Results: Of the 32 fractures, 30 consolidated and there were no avascular necrosis of the humeral head. A fracture has evolved to pseudarthrosis. One patient abandoned follow-up 4 weeks after surgery, and was therefore not possible to assess the consolidation.

17 patients were assessed with mean follow-up of 18 months (4–52 months). The mean Constant score obtained was 66.2 points (53–90).

3 months after surgery all patients resumed their daily activities to the level before the fracture.

Discussion and Conclusion: This minimally invasive technique provides good stability, with minimum damage of soft tissue and vascular preservation of the humeral head.

Our choice is based on the number of consolidations achieved through this technique and functional evaluation of these patients, which we consider satisfactory, taking into account that the functional requirements are lower than those of a young person.

Intramedullary helical implant (helix wire) is simple and biological, suitable for elderly patients with poor bone, which enables percutaneous osteosynthesis using the techniques of indirect reduction and the association, when appropriate, of cannulated screws.