A novel method of image-based navigation in fracture surgery.

The treatment of three- and four-part fractures of the humeral head is still controversially discussed. Some advocate primary arthroplasty while the results of primary fixation seem to be superior if no necrosis of the humeral head develops. Today navigation is used in orthopaedic surgery mainly for interventions on the spine, the pelvis and arthroplasty. In trauma surgery it is still rarely used and some technical problems need to be overcome. We report on a case of a three part fracture of the humeral head with mini-open reduction and fixation with image-based guided headless compression screws. For the fixation each screw was placed on the first trial, total radiation time was 60 s. At 12-month follow-up assessment radiographs showed a consolidated fracture, no loosening of the screws and a good glenohumeral articulation. The patient had free function of the shoulder and no pain, the constant score was 98 and the dash score 0. There is no evidence of a necrosis of the humeral head. The literature focuses on shoulder arthroplasty. There are no reports on the use of image-based guidance in shoulder traumatology so far. In conclusion, the described technique allows an accurate fixation of the humeral head fracture as the guidance system (Surgix) ensures the "first try first hit" screw positioning. The new system was integrated in the workflow and supports the surgeon as an aiming device. The role of navigation system in enhancing minimally invasive surgery of the shoulder should be further explored.