Management of Two-Part and Three-Part Proximal Humerus Fractures Using a Novel Mini-External Fixation Technique

Background: The concept of ‘biological fixation’ which stresses on the preservation of blood supply to the fracture fragments has led to an increased popularity of closed reduction and external fixator application for the management of displaced proximal humerus fractures. In this study, we have described our novel surgical technique of ‘mini-fixator’ application for 2-part and 3-part displaced proximal humerus fractures, along with their radiological and functional outcomes at 6-months follow-up. Method: This is a retrospective study involving 119 patients with displaced 2-part or 3-part proximal humerus fractures treated with closed reduction and a novel mini-fixator application technique. Fracture reduction was assessed using Paavolainen criteria. Head-shaft angle (HSA) was calculated on the pre-operative radiographs, immediate post-operative radiographs and 6 months follow-up radiographs. Depending upon the clinical evaluation (pain, ROM, function) and radiological signs of union, the fixator was removed at the end of 6 to 8 weeks. Functional assessment was performed using CONSTANT score at 6 months follow-up. Results: Mean age of the study population was 61.6 years with 46% males and 54% females. Union was achieved in 116 patients (97.5%) at mean duration of 7.8 weeks (range 6 to 14 weeks). There was statistically significant improvement in the mean HSA in the immediate post-operative and 6 months follow-up radiographs as compared to the pre-operative radiographs with p value < 0.05. As per CONSTANT score, 26.9% patients showed excellent result, 64.7% patients showed good result, 6.7% patients showed fair result and 1.7% patients showed poor result. Complications were seen in 18 cases which included 10 pintract infections, 2 pin-loosening, 2 secondary displacements requiring revision, 1 non-union and 3 shoulder stiffness cases. Conclusion: Closed reduction and external fixation is a safe and effective option for surgical management of displaced 2-part and 3-part proximal humerus fractures. Our technique of mini-fixator application provides a more compact and cost-effective alternative than conventional external-fixators, without compromising the stability of the construct.