[Osteosynthesis using the "palm-tree" nail technic in fractures of the surgical neck of the humerus].

Presented in 1974, this technique consists of internal fixation of the humeral neck by means of three divergent K-wires. These are introduced through a proximal entry point located on the lateral aspect of the humeral diaphysis at the lower end of the "V" shaped insertion of the deltoid which is one of the three subcutaneous areas of this bone. The two principles of this technique are: anchorage of the epiphysis by three divergent pins driven into the cancellous bone of the head and introduction of the pins from a very proximal point that allows easy access across the fracture without the disadvantages of nerve and joint proximity, as in other techniques involving other pins through the olecranon fossa (April), or medial epicondyle or lateral (Vichard). Moreover, this technique is quite different from the Hackethal technique by nails introduced through the olecranon fossa. An oblique hole is drilled at the selected point, and three 2 mm K-wires, after bending their ends are introduced into the medullary canal. After reduction of the fracture, they are driven into the cancellous humeral head bone. By turning the handle, the pins are made to diverge. Exceptionally, operative reduction is necessary by a separate axillary approach. X-ray control or the use of an image intensifier permits one to see if a K-wire is too long and to pull it out somewhat. No cast, no operation splinting, is used. Active and passive mobilization is possible the next day so the functional results are excellent in most cases. Pin removal is possible after 3 weeks in children and 5 in adults. The indications are all the upper extremity humeral fractures, and especially in children (epiphyseal fractures); in adults and aged people, except comminuted fractures.