Percutaneous fixation is a well recognised technique in the treatment of three-part and four-part fractures of the proximal humerus. Minimal fixation of these fractures do show good functional outcome and may further reduce the incidence of avascular complications. We report a preliminary series of 11 patients who underwent percutaneous minimal fixation of such complex humeral fractures using a new technique. 11 consecutive patients (7 with three-part fractures and 4 with four-part fractures) treated by percutaneous limited fixation in our Hospital were involved in this retrospective study. There were 7 fractures with valgus displacement. Percutaneous technique was employed using small incisions and the fracture was reduced under image guidance. The three-part and the four-part fractures were essentially converted into two part fractures, i.e. only the greater and the lesser tuberosities were re-attached to head with AO cancellous screws after realignment of the fragments. The shaft of the humerus was not fixed to the head in any of the cases. All of these cases had a minimum follow-up of at least 6 months. The results were evaluated using the Constant -Murley Shoulder score. 1 out of 11 cases had to be converted to hemi-arthroplasty due to secondary redisplacement of the fracture. The remaining 10 cases showed good bony union although the greater tuberosity in 2 cases showed a residual superior displacement of 3mm and a residual valgus displacement in 2 out of 7 cases. There were no complications of avascular necrosis in any of the cases. Clinically, compared to the uninjured side the average constant score was 93.7% (range- 68.7% – 100%). 7 patients were very satisfied and 4 were satisfied with the operation. Percutaneous minimal fixation achieves good to very good functional outcome comparable to the conventional methods and theoretically reduces the incidence of infection, avascular necrosis and neurological complications.

We conducted a prospective evaluation of patients with anterior dislocation of the shoulder associated with a fracture of the greater tuberosity.

Thirty-four anterior dislocations of the shoulder with greater tuberosity fractures were reviewed with a minimum follow-up of one year from the time of injury. Eight required open reduction. The final outcome with regard to pain, range of movements, and function was assessed in 34 patients. In open reduction, there were five good results, one fair, one poor and one patient died.

In the non-operative group, results were good in 11 patients, fair in eight, poor in one, not assessed in five and one patient died. Two patients have died in this series, one in the open reduction group. Associated injuries are: axillary nerve damage (three), brachial plexus injury (one), loose fragment under the acromion (one) and stiffness of the shoulder (three)

Anterior dislocations of the shoulder with fracture of the greater tuberosity do not always lead to good results. Close observation after reduction is important to check for later displacement of the fractures.