Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures

Abstract

The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail (Targon-PH) led to good functional results, especially in 2- and 3-part fractures. There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures. Lateral backing out of screws was abolished by implant modifications (PEEK-inlay) from 2003 onwards. Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement.

Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures

“…One year postoperatively, the mean Constant and Murley score of the injured side for our patients was 72 points corresponding to 87% of the score on the contralateral side. In some other studies, the mean Constant and Murley scores after angular stable plate or angular stable nail fixation of proximal humeral fractures ranged between 72 and 89 points [12,17,21,28,30], which also are comparable to our results. Nevertheless, most of these published studies do not distinguish between different fracture types.…”

“…For displaced and unstable proximal humeral fractures, many surgical techniques have been described [5,11,12,18,19,26,27,32], but no single approach is considered the standard of care. Most studies included a small number of patients and did not distinguish between different fracture types, eg, three-and four-part fractures.…”

“…Treatment options of displaced and unstable proximal humeral fractures vary widely, implying a lack of consensus regarding optimal management of these injuries [14,30,31]. The goals of surgery are to obtain anatomic fracture reduction and stable primary fixation to ensure rapid fracture healing and immediate postoperative functional therapy without prolonged immobilization [11,12].…”

“…Alternately, rotator cuff tears occurring after antegrade nailing might negatively influence a patient's functional outcome [12]. For both devices, implant-related complications such as nail or plate impingement and secondary screw perforation have been reported [9,12,25,29].…”

“…Alternately, rotator cuff tears occurring after antegrade nailing might negatively influence a patient's functional outcome [12]. For both devices, implant-related complications such as nail or plate impingement and secondary screw perforation have been reported [9,12,25,29]. Only a limited number of prospective clinical studies comparing the results after operative stabilization of proximal humeral fractures using different implants have been published and most of these studies included a small number of patients [13,22,28].…”