Closed Reduction and Percutaneous Pinning (CRPP) for Proximal Humeral Fractures – are we Able to Preserve Fracture Reduction in this Surgical Technique?

Background: Fractures of the proximal humerus are complex injuries with significant morbidity. the vast majority of these fractures is associated with osteoporosis. Various treatment options are available, determined by the pattern of the fracture, the quality of bone, goals of daily function and the surgeon`s experience. CRPP for displaced proximal humeral fractures is one of the described techniques with clear advantages over open reduction techniques.

The purpose of this study was to evaluate the sustainability of post-operative reduction after CRPP.

Methods: A retrospective study of patients who underwent CRPP in our institute between the years 2014-2016. We recorded data for 70 patients with an average age of 62, 74% female and average follow-up of 26 weeks. Fractures were classified according to Neer classification. Last Follow up x-rays were evaluated by a senior orthopedic shoulder surgeon and a senior musculoskeletal radiologist. Both defined the fracture pattern and reduction maintenance in follow-up radiographs.

Results: Of 70 patients who underwent Closed reduction and percutaneous pinning, 22 (31%) patients had a 2-part fracture of the surgical neck (SN), 46 patients (66%) had a 3-part proximal humeral fracture of the SN, and greater tuberosity (GT), and 2 (3%) patients had a 4-part fracture.

In 57 (81%) of the patients, fracture reduction was maintained during the entire follow-up period.

Loss-of-reduction or malunion was identified in 13 (19%) patients; 5 (23%) in the 2-part group, 7 (15%) in the 3-part group and 1 (50%) in the 4-part group. In total, 3 (4%) patients required revision surgery.

Conclusion: CRPP is a viable option for the treatment of 2-part and 3-part displaced proximal humeral fractures. It is a safe and simple procedure with a low complication rate and a low revision rate.