J Korean Fract Soc.  2007 Apr;20(2):184-189. 10.12671/jkfs.2007.20.2.184.

Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis

• Chung ST
• Kim JH
• Kim HS
• Park SJ

• KMID: 2295578
• DOI: http://doi.org/10.12671/jkfs.2007.20.2.184

Abstract

PURPOSE
To evaluate the usefulness of internal fixation with modified Steinmann pins and tension band wiring technique in comminuted proximal humeral fracture with osteoporosis and the correlations among bone mineral density, age, Neer's score and period of union.
MATERIALS AND METHODS
Twelve cases of comminuted proximal humeral fracture with osteoporosis were surgically treated with modified Steinmann pins and tension band technique, and followed up for an average 20.8 months (range, 6~39 months). Average age was 73.6 years old (range, 59~85 years old). Results were assessed using Neer's evaluation criteria.
RESULTS
Excellent results were noted in eight cases and satisfactory results in four cases. Radiological union was obtained in all cases. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal. One case developed operative wound infection, which were managed by antibiotics therapy, irrigation and secondary closure.
CONCLUSION
Internal fixation using modified Steinmann pins and tension band wiring technique for proximal humeral fracture, with osteoporosis, makes complete union of fracture, minimizes risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.

Keyword

Proximal humeral fracture; Osteoporosis; Modified Steinmann pin

MeSH Terms

Anti-Bacterial Agents
Bone Density
Fractures, Comminuted*
Osteoporosis*
Rehabilitation
Shoulder Fractures
Wound Infection
Anti-Bacterial Agents

Figure

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  Fig. 1 (A) Modified steinmann pins have different sizes. (B) Modified steinmann pin has proximal two holes.

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  Fig. 2 (A) Initial radiograph shows a surgical neck fracture of the proximal humerus, eighty five-year-old woman. (B) Postoperative radiograph shows intramedullary fixation with two modified Steinmann pins and one tension band wiring.

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  Fig. 3 (A) Initial radiograph shows a 3 part fracture of the proximal humerus sixty eight-year-old woman. (B) Postoperative radiograph shows intramedullary fixation with two modified Steinmann pins and two tension band wirings.

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  Fig. 4 This graph shows a correlation between age and average of Neer's score.

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  Fig. 5 This graph shows a correlation between age and average of union period.

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  Fig. 6 This graph shows a correlation between BMD and average of union period.

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