Abstract
Introduction: The purpose of this retrospective study was to evaluate the results of retrograde pinning, according to Hacketal procedure, for unstable fractures of the humeral neck with particular attention to three and four part fractures.
Materials and Methods: Between 7/1990 and 4/2001, we treated 44 patients (26 females and 18 males) ranging in age from 16 to 92 years (mean: 59/5 years). 75% of the cases followed a domestic trauma. Using Neer classification there were 30 two part fractures, 12 three part and 2 four part fractures. After closed reduction was performed under biplane image intensification, a small incision was made to expose the distal humerus by blount dissection. A 5 mm hole was drilled. Three to five prebend Kirschner (25 cases) or Metaizeau pins (19 cases) were introduced retrograde achieving a ‘bouquet’-type fixation within the humeral head. Post operatively, the arm was immobilized in a Mayo-type sling for 2–3 weeks. Then mobilization was started in all directions except rotation, who was cautiously done later. The results were evaluated according to consolidation, pain and range of motion. Complications associated with the treatment were recorded. We considered as excellent results, asymptomatic shoulder with full motion, good results patients with slight pain or reduction of motion and bad results, those with any pain, valuable restriction of motion and functional handicap.
Results: The mean follow up was 21/7 months. Two patients died before callus formation. All patients were re-examined or contacted by phone. No patient was lost to follow-up. The mean hospitalization range was 6.4 days. Two patients had loss of fixation. Fractures united with callus formation in 4 to 8 week. Patients regained a full range of motion in 64% of the cases, 88% were free of pain. No avascular necrosis was noted in that series.
The functional outcome was excellent in 64% of the cases, good in 21.5% of the cases. Pins removal was almost necessary for proximal pins migration in 45% of the cases and distal migration in 7.5% of the cases.
Discussion: The overall finding of good results in this series compares favorably with results of other operative treatment. We believe that our technique offers distinct advantages: few displacement, no osteonecrosis but our follow-up can be considered as insufficient. Migrations of the pins remain a matter of concern.
Conclusion: Retrograde pinning by the olcranon fossea is a demanding technique which makes sense biologically from the stand point of respect of vascularity. It is a useful alternative to open reduction and internal fixation. In three or four part fractures, it has to be tested before primary hemiarthroplasty.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
