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 over open techniques that limit the exposure, minimizing surgical trauma and reducing the risk of necrosis. The aim of mis study is to evaluate results of three and four part humeral head fractures in 3-4 ASA(American Society of Anesthesiologistsistatus patients treated with closed reduction and percutaneous pinning. Materials and methods: From 2007 and 2009, 26 patients mean aged 78 years old(range:70-87)were enrolled for this study. Criteria of inclusion were three or four part displaced humeral head fracturelfractures classined radiographically following Neer's system),ASA status of 3 or 4(open reduction highly non recommendedland absence of vascular or nervous deficits. All patients were treated with the MIROS(Minima||y Invasive Reduction and Osteo synthesis System)systern, which consists in 4 l<-wires, 2 introduced from the proximal humeral metatisis and 2 from the fragments of the humeral head, and then threatened by a single external clevice.Post-operatively, 3D° of abduction and flexion were allowed. At a mean follow-up of 13 rnonths(range: 8-24), patients were clinically valued with the Constant Score and a radiograph of the shoulder in two view was obtained. Results: At the follow—up, Constant scores were 58.8 +-18 points for the injured shoulder and 68.9 +-9 points for the opposite shoulder Reduction and healing of the fracture was good in 22 cases(84.6%); in 4 cases, resorption of the greater tuberosily was observed. Discussion: Open reduction-internal fixation is usually recommended 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. In our series of patients, open reduction was not possibile and only conservative treatment or percutaneous pinning was allowed. With this technique, we obtained good results with very low morbidity. The MIROS system should be considered as a valid treatment in these challenging cases.