DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.017

Pages: 2190-2194

Varus-impacted four-part fractures of the proximal humerus are the least forgiving pattern within this family of injuries, since varus angulation implies shortening of the medial calcar or disruption of the medial hinge, both of which are strong predictors of humeral head ischaemia. Published series of percutaneous fixation report markedly poorer outcomes in four-part patterns than in simpler configurations, and some authors advise that alternative strategies be preferred. We report an 80-year-old woman who sustained a varus-impacted four-part fracture of the right proximal humerus after a low-energy fall with direct impact on the shoulder, confirmed by computed tomography. She underwent same-day closed reduction and percutaneous fixation with three Kirschner wires under general anaesthesia and fluoroscopic guidance, the wire ends being bent and left protruding through the skin. The postoperative course was free of complication, with no pin-tract infection despite nine weeks of transcutaneous wire retention, no secondary displacement and no neurological deficit. The wires were removed at nine weeks once consolidation was radiographically evident. At three months the fracture had united and the patient had regained a restricted but functionally adequate shoulder, essentially free of pain and sufficient for independent activities of daily living. Percutaneous fixation remains a defensible option in low-demand elderly patients whose fracture reduces closed, particularly where arthroplasty is not readily accessible, but a three-month assessment cannot exclude avascular necrosis and longer surveillance is obligatory.