Fixator-assisted Nailing in the Treatment of Fractures and Varus Malunions of the Proximal Humerus

Introduction: Fractures and malunions of the proximal humerus lead to functional impairment, especially limitation of abduction. Our aim was to develop a mini-invasive technique of correction of typical varus deformity providing easy closed nailing.

Methods: 56 patients with 2-part fractures (41/56) and malunions of the proximal humerus (15/56) were operated. The technique featured small wire temporary external frame with two k-wires in the humeral head for spatial control. In case of acute fracture it allowed to reach alignment and proper length. In case of malunions percutaneous osteotomy of the surgical neck was performed prior to fixator application, and alignment was reached acutely by the fixator. Then closed intramedullary nailing was performed through a stab wound.

Results: The technique allowed to restore anatomy of the proximal humerus and avoid varus malalignment. Mini-invasive approach provided fast functional recovery. 41/56 patients were available for follow-up in 1 year. 39/41 fractures and osteotomies healed, in two nonunions exchange nailing was performed. Patients demonstrated significantly increased shoulder function and quality of life.

Discussion and Conclusion: The presented technique provides easy and reproducible way of mini-invasive restoration of anatomy of the proximal humerus in two part fractures and varus malunions. It results with low complication rate and good functional outcomes. Its feasibility in more complex injury patterns requires further research.