Intramedullary Locking Nail Fixation of Proximal Humerus Fractures: Rationale and Technique

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

“…9). 3,4,9 No cases in our series showed screw migration or loss of reduction, thanks to the polyethylene bushing located inside the proximal part of the nail, which allows efficient locking of the proximal screws. 9 The use of curved design second-generation humeral IMNs has been associated with even poorer results and high rates of complications and reoperations.…”

“…14 Because most of these nails were too large and too long, distal nail engagement with the humeral canal could occur before the fracture had completely healed, leading to surgical neck nonunion. 3,4,23 No case of surgical neck nonunion was seen in our patients, possibly owing to the small diameter of our nail (9 mm), its short length (13 cm), and the low profile of its distal tip. Another major disadvantage of the first generation of humeral nails was inadequate security of the proximal screws leading to hardware problems, loss of reduction, and the need for unexpected reoperations.…”

“…The straight nail respects the 3-dimensional geometry of the proximal humerus, acting as a mechanical strut to support the humeral head under compressive forces. [3][4][5]7,54 The proximal locking screws are captured by a polyethylene bushing, which provides an angular-stable construct preventing screw back out and migration. 9 The proximal screws are tuberosity oriented (ie, not humeral head oriented) to avoid glenoid erosion in case of humeral head avascular necrosis and collapse.…”

“…This cannulated nail is short, has a small diameter, has a straight design (to enter the muscular portion of the supraspinatus), and uses locking screw technology with orientation of the screws for tuberosity fixation. 3,4 The aims of this study were (1) to classify displaced surgical neck fractures to determine the optimal entry points for percutaneous IM nailing and (2) to report the functional and radiologic results of this thirdgeneration nail for the treatment of displaced 2-part surgical neck fractures using a percutaneous technique for nail insertion. We hypothesized that (1) the entry point for percutaneous insertion of an IMN would depend on the displacement of the humeral head fragment and (2) percutaneous fixation of displaced surgical neck fractures with a third-generation IMN would provide a high rate of fracture healing, excellent clinical outcomes, and a low rate of complications.…”

Intégrité de la coiffe des rotateurs et fonction de l’épaule après enclouage antérograde percutané des fractures de l’humérus

“…(2)(3)(4) Les clous de 3 ème génération ont été conçus avec l'objectif d'éliminer les complications rencontrées avec les clous de 1 ère et 2 ème génération. (1,3,5) Il s'agit de clous droits, courts, de petit diamètre destinés à être introduits au travers de la partie musculaire du supraspinatus (et non pas sa partie tendineuse) puis dans le sommet de la tête huméral. Alors que le risque de lésion tendineuse de la coiffe des rotateurs après EAP huméral a été étudié pour les clous de 2 de génération (6,7), aucune étude n'a évalué ce risque pour les clous de 3 ème génération.…”