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The “FraMo” System

A New Mini-Invasive Technique in the Treatment of Proximal Humerus Fractures

Moro, Gian Luigi MD*; Mezzadri, Umberto MD; Mancini, Nikj MD*; Naim Rodriguez, Nadim MD; Tartaglia, Giuseppe MD§; Gatti, Michele MD; Pedretti, Alberto MD; Fraschini, Gianfranco MD*

Techniques in Hand & Upper Extremity Surgery: September 2019 - Volume 23 - Issue 3 - p 102–110
doi: 10.1097/BTH.0000000000000246

Fractures of the proximal humerus are relatively common injuries in adults accounting for 5% of fractures. Nowadays the most common technique used is open reduction internal fixation with LCP plates. The risks associated with open reduction internal fixation had led us to develop and apply a “hybrid” system, which is based on external fixation and closed surgery principles. This system is capable of stabilize up to 4 fragment fractures on different planes while conferring a strong enough fixation to maintain fracture reduction while allowing the patient to perform passive and active movement since the first day following the surgery. Our study group started on November 2009 until December 2015 and consisted of 118 patients with a mean age of 68.84±10.52 years for females (76) and 65.62±12.56 for males (44). Patients were classified according to the AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma association) Classification. In a few patients we performed mini lateral accesses to allow reduction of the humeral head and greater tuberosity. Shoulder mobilization was initiated from the first day following surgery. The external fixator was removed at 5 weeks with successive check-ups at 3, 6, and 12 months. The majority of type B and type C1 fractures had almost a complete functional recovery. Patients also, especially in the elderly, reported a good quality of life without pain during any range of motion. Our group of patients, after removal of the apparatus at 5 weeks following the surgery, had a mean articular range of motion with active abduction of 90 degrees and about 100 degrees with passive abduction. Postoperative CS scores at 12 months follow-up was 75,47±8.02. In addition there was also significant (P<0.05) improvement between preoperative and postoperative visual analog scale measurements (in cm), 7.67±2.70 and 1.71±2.08, respectively. This technique has shown good functional results with reduced surgical risks and complications that are typical of open reduction surgical fixation of proximal humerus fractures, is quick in execution and minimally invasive. Given the very good results of the study of this new external fixation technique has shown to be a viable option for the treatment of proximal humerus fractures.

*Department of Orthopedics and Traumatology, IRCCS San Raffaele Hospital

Department of Orthopedics and Traumatology, Ca’Granda Niguarda Hospital

§Faculty of Medicine, Vita-Salute San Raffaele University

Department of Occupational Medicine, University of Milano, Milan

San Martino Clinic, Malgrate, Italy

Department of Surgery, University Hospitals of Geneva, Geneva (CH), Switzerland

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Nadim Naim Rodriguez, MD, Department of Surgery, Rue Gabrielle-Perret-Gentil 4, Genève 1205, Suisse. E-mail:

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