Transosseous Suture Fixation of Proximal Humeral Fractures

Panayiotis Dimakopoulos, MD

The management of displaced proximal humeral fractures is challenging and often reflects the personal experience of the physician treating the injury. Regardless of the treatment protocol that is employed, these fractures pose difficulties in terms of restoring humeral alignment, joint surface congruity, and rotator cuff function while maintaining humeral head vascularity. Treatment options include nonoperative methods, open reduction and internal fixation, and hemiarthroplasty. However, each is associated with a high risk of complications. Nonoperative treatment is preferable for minimally displaced or impacted fractures, but the results may be poor as the fracture fragments can become displaced. Hemiarthroplasty is most often considered for four-part fractures, fractures in which the head is split, or fracture-dislocations. In most series, the outcomes of hemiarthroplasty have been unpredictable and at times disappointing. Open reduction and internal fixation with standard or modified plates can provide favorable results, however hardware failure, infection, and osteonecrosis are risks, especially when the fracture is comminuted or associated with severely osteopenic bone. Current trends in the operative treatment of proximal humeral fractures have been toward less invasive techniques of reconstruction, with limited soft-tissue dissection and minimal amounts of hardware to achieve stable internal fixation. Lately, low-profile locking plates and intramedullary nails have been introduced, with promising early results. Over the last fourteen years at the University Hospital of Patras, Greece, Panayiotis Dimakopoulos, MD, PhD, has used transosseous suture fixation for a large number of displaced proximal humeral fractures with good results and recommends open reduction and suture fixation for acute four-part valgus impacted, three-part, and two-part greater tuberosity fractures of the proximal part of the humerus for achieving stable osteosynthesis, an adequate rotator cuff repair, and early mobilization of the shoulder joint.

Material Covered

• Introduction
• Surgical Technique

Specifications

• Total Run Time: 21:20 minutes
• Catalog Number: 4078
• VJO Publication Date: March, 2009