Percutaneous pinning of 3-or 4-part fractures of proximal humerus in elderly patients in poor general conditions: MIROS® versus traditional pinning

Introduction Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general conditions. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. Aim To evaluate the results of percutaneous fixation of 3- or 4-part fractures of proximal humerus of patients in ASA (American Society of Anesthesiologists) physical status 3 or 4 treated either with MIROS or traditional percutaneous pinning (TPP). Methods 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Preoperatively, anteroposterior and transthoracic or axillary radiographs were obtained in all cases and CT scans in patients with most complex fractures. Follow-up evaluations were carried out at 3, 6,12 and 16 weeks, and 6 months, 1 year and 2 years postoperatively, using the Constant Score (CS) and Subjective Shoulder Value (SSV) methods. Results 52 of the 58 patients could be evaluated at all follow-ups. In both 3- or 4-part fractures there were significantly higher CS and SSV scores in the MIROS compared to TPP group at all late follow-ups. A lower rate of deep infection, pin tract infection and pin mobilization were found in the MIROS group (p<0.001). In both groups there was a significant association between final result (CS) and either the type of fracture and complications (p<0.001). Conclusion The MIROS gave better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general conditions.