Proximal humerus fractures treated with a modified palm tree technique.

PURPOSE: Several surgical techniques have been used for shoulder fracture treatment. In 1989, Kapandji described the 'Palm Tree technique' for the first time, consisting of inserting three K-bent wires through a bone hole created under deltoid muscle insertion. The purpose of this study was to evaluate clinical and radiographic results of proximal humerus fractures treated by a modified "palm tree technique." METHODS: From August 2021 to March 2025, 43 patients with proximal humerus fractures underwent surgical treatment using the modified Palm Tree technique. The mean age was 61.8 years (range, 17-85 years), with a mean follow-up of 17.4 months (range, 6-24 months). According to the Neer classification, two-part, three-part, and four-part fractures were treated by this technique, all performed by the same surgeon. Clinical outcomes were assessed using the Constant Score, UCLA Shoulder Rating Scale, and DASH scores. RESULTS: A total of 43 patients were included in the final analysis. The mean Constant Score was 79.3 ± 25.4, the mean UCLA score was 27.3 ± 10.0, and the mean DASH score was 18.5 ± 25.9. Six cases (14.0%) of K-wire migrations were encountered whereas two cases (4.7%) of avascular necrosis of the head required shoulder arthroplasty. One patient developed non-union (2.3%) and another secondary loss of reduction. No neurovascular injury or fracture at the entry site has been reported. CONCLUSIONS: The modified Palm Tree technique appears to represent a feasible, joint-preserving, minimally invasive treatment option for selected proximal humeral fractures, providing favorable functional and radiographic outcomes. Careful patient selection remains essential, particularly in elderly patients with poor bone quality.