Three and four part humeral head fractures in 3-4 ASA status patients treated with closed reduction and percutaneous pinning (MIROS system).

Introduction. Closed reduction and percutaneous pinning for displaced humeral head fractures offer advantages versus open techniques since they limit the exposure, thus minimizing surgical trauma and reducing the risk of necrosis. The aim of this study is to evaluate results of three- and four-part humeral head fractures in 3-4 ASA {American Society of Anesthesiologists) status patients treated with closed reduction and percutaneous pinning. Material and methods .From 2007 to 2009, 26 patients mean aged 78 years (range: 70-87) were enrolled for this study. Criteria of inclusion were three- or four-part displaced humeral head fracture(fractures classified radiographically following Neer’s system),ASA status of 3 or 4 (open reduction highly non recommended) and absence of vascular or nervous deficits. All patients were treated with the MIROS (Minimally Invasive Reduction and Osteo.synthesis System) system , which consists in 4 k-wires, 2 introduced from the proximal humeral metafisis and 2 from the fragments of the humeral head and then threatened by a single external device.Post- operatively, 30° of abduction and flexion were allowed. Discussion. Open reduction and internal fixation is usually recommented in displaced 2 and 3 part proximal humeral fractures, whereas hemiarthroplasty is commonly accepted for the management of 4-part fractures and complex fracture-dislocations. The Miros system should be considered as a valid treatment in these challenging cases