Treatment of mild to moderately displaced proximal humerus fracture with no significant angulation or medial cortical comminution
This protocol applies to proximal humerus fractures with mild to moderate displacement where the fracture pattern allows stabilisation without open reduction — specifically when significant fragment displacement or angulation is absent and there is no medial cortical comminution of the proximal humerus.
Clinical scenario
Mild to moderately displaced proximal humeral fracture where open reduction is not required. The absence of significant displacement or angulation of the fracture fragments, and the absence of medial cortical comminution, define the eligibility for this approach. Significant displacement, angulation, or medial cortical comminution are the main contraindications.
Treatment approach
Management involves a minimally invasive surgical technique — percutaneous pinning — which, while the least invasive option available, demands considerable surgical experience and dexterity. The complete fixation strategy and procedural detail are available in the full protocol.
References
DOI: 10.1016/j.jcot.2019.04.016
- It is indicated in mild to moderately displaced fractures where open reduction is not required.
- The main contraindications for this technique include a significant displacement or angulation of the fracture fragments and medial cortical comminution.
- Percutaneous pinning: Though the least invasive, it needs considerable experience and dexterity.
- A minimum of two Kirschner wires (K wires) must be placed to stabilize each displaced fragment.