Four-part fractures of the proximal humerus usually are treated with prosthetic replacement to avoid nonunion, malunion, nor avascular necrosis of the humeral head. We performed open reduction and internal fixation for this fracture by intramedullary pin and wire. The purpose of this study was to introduce our method and to evaluate the postoperative results. They consisted of three males and eight females whose averaged age was sixty-four years. The operative technique: the delto-pectoral approach allowed adequate exposure of the fracture site. The humeral head and shaft were fixed by two intramedullary Ender or Rush pins through the rotator cuff. The rotator cuff and humeral shaft were fixed by a wire extramedullary. Nine of the eleven fractures healed without postoperative displacement nor avascular necrosis. Necrosis of the humeral head occured in one case. In those ten fractures, postoperative follow-up periods was from one year to six years and two months, averaged two years and eight months, and the JOA score went from 73 points to 100 points, averag 82.4 points. In only one case of senile dementia, was the prosthetic replacement performed for a re-fracture of the humeral head. Our method by minimal fixation was minimally invasive for the soft tissue and blood supply of the humeral head fragment, and advantageous to revasculization of the humeral head fragment, and very useful for four-part fractures of the proximal humerus.
