ABSTRACT
Nonoperative treatment of displaced humeral head fractures does not lead to satisfying results (1-4). Reduction of the fragments is therefore essential, although there is a danger that reduction by open surgery may increase the risk of avascular necrosis (AVN) in four-part fractures and four-part fracture dislocations. The risk of AVN is increased further, however, by exposure of the fracture as required for plating osteosynthesis in comparison to the exposure required for minimal osteosynthesis (5-7). Open minimal osteosynthesis is therefore the treatment of choice, at least in younger people, due to the fact that the survival time of a prosthetic implant is limited (5,6). In order to avoid the additional risk of AVN involved in open surgery, percutaneous treatment is an even more desirable procedure.
