Fixation of Proximal Humeral Fractures with an Intramedullary Nail: Tipps and Tricks

Abstract

Antegrade interlocking nailing has been established as a valid option of treatment in proximal humeral fractures which follows the principles of minimum invasive surgery. The introduction of angular stability into intramedullary nailing has increased the stability of reconstruction even in osteoporotic fractures. The outcome of the surgical procedure essentially depends on the adequate intraoperative management of the specific features and challenges of the corresponding fracture type. The creation of the correct nail entry point is crucial for anatomic reduction and stability of the reconstruction, as well. The knowledge on intraoperative reduction aids and additional tools of enhancing the stability of the reconstruction alleviates a mechanically sound application of antegrade intramedullary nailing in most highly unstable proximal humeral fractures.

Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?

“…Two devices have been introduced to treat displaced proximal humeral fractures: an antegrade angular stable intramedullary nail [26,32,33] and an angular stable plate [13,18,22]. Both devices are intended to achieve maximum primary angular stability by three-dimensionally arranged interlocking screws at the humeral head level.…”

“…Frequently applied methods to treat displaced proximal humeral fractures include minimally invasive techniques with Kirschner wires/sutures and/or screw fixation, plate fixation, intramedullary interlocking nailing, and hemiarthroplasty. The choice of surgical technique depends on the fracture type and the patient's age, bone quality, and functional expectation [2,12,13,22,29,[33][34][35][36].…”

Humerus axial projection. New intraoperative radiological projection proposal for proximal humeral fractures treatment by intramedullary nailing

“…Authors concluded that to prevent mobilization and improve results, nail and screws must be applied in the regions with the highest trabecular density (22). Other studies confirmed that there is a lower risk of mobilization, as well as correct positioning of the nail, when the proximal screws reach within few mm of the epiphyseal cortex (17,20,22,23), owing to the higher bone density of this subchondral bone area. However, this is also a risk because screws may protrude into the joint, causing joint damage and functional impediment.…”

PHN for treatment of proximal humerus fractures: evaluation of 80 cases

“…Several authors recommend surgery with an endomedullary nail as the treatment of choice in displaced fractures with two or three fragments according to Neer's classification, in that it is a good compromise between minimally invasive treatment and the insertion of a plate, reserved for younger patients. The literature contains reports of endomedullary nailing with proximal screw locking [1,2,5,7,8] or wires [4,6]. Proximal humerus nailing, used in our cases and mentioned in recent literature [9][10][11][12], has a proximal locking mechanism with a spiral blade.…”