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Ann R Coll Surg Engl. 2009 September; 91(6): 517–518.
PMCID: PMC2966211
Technical Notes and Tips
Bruce Campbell, Section Editor

A Novel Technique for Humeral Head Retrieval

BACKGROUND

Four-part fracture dislocations of the proximal humerus are a common surgical problem (Fig. 1). They are usually treated with a hemi-arthroplasty. In the minority of cases where the head of the humerus has dislocated anteriorly, removing the head can be difficult. We found that applying a bone anchor into the humeral head facilitated atraumatic extraction of the retained head fragment.

Figure 1
Three-dimensional computed tomography reconstruction of a four-part proximal humeral fracture.

TECHNIQUE

A bone anchor (Depuy Mitek Rotator Cuff Quickanchor™ Plus; DePuy Mitek, Inc., Raynham, MA, USA), is inserted eccentrically into the dislocated humeral head (Fig. 2). The needles at either end are cut off and the suture ends are then pulled (Fig. 3). The humeral head then rolls out of its cavity without the need to use supplementary instrumentation.

Figure 2
Bone anchor inserted into humeral head.
Figure 3
Humeral head retrieved with suture ends in situ.

DISCUSSION

Retrieval of the humeral head can be difficult when the head is dislocated antero-inferiorly. The fragment is often too small to accommodate an extraction device; in addition, inserting a corkscrew extractor can push the fragment more medially. Insertion of the Mitek anchor requires little force medially and allows head retrieval in a controlled fashion avoiding head fragmentation and allowing for accurate head size measurement.


Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England