Combined percutaneous retrograde intramedullary pinning and open reduction and screw fixation in the treatment of displaced Neer three-part fractures of the humerus

Introduction: Fractures of the proximal humerus are common injuries. Treatment options vary according to fracture patterns, surgeon preferences and implant availability. Increasing interest is being given to minimally invasive surgical procedures. In this article an original surgical procedure is described combining Percutaneous Retrograde Intramedullary Pinning (PRIP) and open reduction with lag screw fixation in the treatment of displaced near three-part fractures of the proximal humerus.

Methods: We report on the preliminary results of a retrospective series of six patients treated with PRIP and open lag screw fixation reviewed with a mean follow-up of 25 months. Radiologic assessment was made on plain x-rays. Functional results were assessed according to the Constant and Murely score, the Disabilities of The Arm, Shoulder And Hand (DASH) score, and the Analogue Visual Score (AVS).

Result: Radiologic reduction was “anatomical” in all the patients. The average Absolute Constant Score (ACS) was 55.16 (range from 30 to 80). The average DASH score was 27.3 (range from 19 to 36). Only one case of proximal pin migration was reported.

Conclusion: The association of PRIP with open reduction and lag screw fixation can be an interesting alternative yielding good results in our developing countries where more advanced fixation devices are not readily available.