FIXATION OF PROXIMAL HUMERAL FRACTURES WITH MODIFIED TENSION BAND TECHNIQUE

Abstract

Introduction: Many methods have been proposed so far in treatment of proximal humeral fractures, which created great deal of controversy and confusion. Most proximal humeral fractures are nondisplaced or minimally displaced and can be satisfactorily treated with a sling and early range of motion exercises. The controversy exists when the fractures are significantly displaced.
Patients and methods: Seven patients, 5 females and 2 males, with proximal humeral fracture; which were operated between February 1996 and January 1999 by the same surgeon and with the same technique, were evaluated. The mean age of the patients was 61,1 (22-81). According to Neer’s classification, the types of fractures were as follows: 2 two-part fractures, 1 three-part fracture, 2 four-part fractures and 2 fracture-dislocations. All shoulders were approached through deltopectoral incision and after open reposition, the fractures were internally fixated with wire and two cortical screws, using modified tension-band technique. Within two weeks of postoperative, all patients were allowed to begin early active motions. The three-phase rehabilitation protocol, which had been devised by Hudges and Neer, was applied to all patients. Average follow up period was 17 (11-35) months. Pain, daily activity, range of motion and power were rated on a 100 point scale according to Constant-Murley’s shoulder rating system.
Results: None of the complications that related to displaced proximal humeral fractures such as loosening of correction, avascular necrosis or myositis ossificans, were seen postoperatively. One patient was considered to have an excellent rating and 6 others were considered to have a good rating.
Conclusion: We believe that, tension-band technique, which we modified through using two cortical screws, is an appropriate method of treatment of displaced proximal humeral fractures. It is not too invasive and it provides securely early motion.