A Multiplanar External Fixator Assembly for Complex Proximal Humeral Fractures: A Novel Management Modality

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Abstract

High-velocity trauma is increasing the frequency of proximal humeral fractures in the younger population. Proximal humeral fractures are the second most common upper-extremity fracture and the third most common fracture after hip fractures and distal radial fractures, in patients who are older than 65 years of age. Overall, this injury tends to follow a bimodal age distribution except 2-part fractures, which follow a unimodal distribution in the elderly. Osteoporotic, comminuted, and displaced fractures of upper-end humerus with or without compromised soft tissue were considered as complex fractures. Displaced proximal-end humeral fractures are often unstable and could be associated with injury of the rotator cuff and avascular necrosis of the head of the humerus. Avascular necrosis of the head is found in 12% to 34% cases of 3-part fracture and 41% to 59% cases of 4-part fracture. The reason attributed to this is an increased risk of loss of blood supply to the head of the humerus in 3-part or 4-part fractures. Many modalities of management, including nonoperative management, percutaneous multiple K-wire fixation, fixators, and open reduction and internal fixation by plate/screws have been described for the treatment of these complex proximal humeral fractures. Despite early exercise programs, the problem of shoulder stiffness is associated with a conservative protocol. To overcome this problem, early mobilization of the joint is mandatory, which is not possible with conservative treatment/K-wire fixator before 3 weeks. Open reduction and internal fixation requires soft tissue stripping, which may lead to higher chances of avascular necrosis of the head of the humerus and stiffness of the shoulder. Thus, the above-described complex fracture patterns present extra challenge to practicing orthopedic surgeons. In this report, we aimed to present a multiplanar external fixator assembly with the technique of indirect closed reduction of complex proximal humeral fractures.

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