How to Transition to Percutaneous Pinning for Proximal Humerus Fractures

摘要

Since Neer's original description of proximal humerus fracture classification and management in 1970,surgeons have attempted to improve on those results. One of the major difficulties with treatment of complex proximal humerus fractures remains the high rate of avascular necrosis (AVN) associated with open reduction and internal fixation (ORIF). As increasing knowledge of the blood supply to the fragments of the proximal humerus surfaced, more surgeons began attempting to minimize disruption of these tenuous vessels, and periosteal connections. Whereas descriptions of percutaneous fixation have been around for years,it was not until 1991, when Jakob and coworkers described the importance of minimal manipulation of these complex fractures, that interest in pinning blossomed.Their description of the "valgus impacted" fracture emphasized the importance of the medial periosteal hinge in the setting of the 4-part fracture. Even with less comminuted proximal humerus fractures, however, preservation of the blood supply is imperative, as AVN can occur even in the setting of non-displaced fractures.