Telegraph antegrade nailing in the treatment of humeral fractures with rotator interval split technique

Abstract

Twenty-four proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. The purpose of this paper was to assess the clinical outcomes of proximal epiphyseal and diaphyseal humeral fractures treated with an antegrade humeral nail implanted after an interval rotator split. We treated six proximal epiphyseal fractures and seven bifocal fractures of the epiphysis and shaft and eleven diaphyseal fractures. The mean follow-up was 23 months (range 12 to 34 months). Twenty patients were available for follow-up. All but two fractures progressed to healing. The Mean Constant score was 80%, Relative Constant score was 95.5%. We divided the clinical outcomes by fracture pattern to define the best surgical indication. There were good clinical outcomes in all three groups, but the clinical score was highest in the shaft fracture group. An intramedullary antegrade nail inserted through the interval rotator without penetrating the rotator cuff had a good clinical outcome and with certain fracture types can be an effective and satisfactory device.

Outcomes of intramedullary nailing for acute proximal humerus fractures: a systematic review

“…Three studies additionally reported on outcomes following IMN of fracture dislocations [ 18 – 20 ], and three studies additionally reported on outcomes following IMN of combined proximal humerus and shaft fractures [ 11 , 21 , 22 ]. Only two of these studies were included, as explicit outcomes data for acute proximal humerus fractures could be elicited [ 11 , 19 ].…”

Modern Perspectives of Open Reduction and Plate Fixation of Proximal Humerus Fractures

“…20,[24][25][26][27] Other complications, including malunion, nonunion, cuff dysfunction, and osteonecrosis, have been described after both percutaneous screw or pin fixation [23][24][25]28 and intramedullary nailing. 19,23,[29][30][31][32][33][34][35][36][37][38][39][40] Conventional buttress plate fixation, using either cloverleaf, buttress or simple semitubular plates, offered the possibility of more rigid fracture fixation, 2,41-51 but fracture displacement was still prevalent as a result of screw cutout in the osteoporotic humeral head. 23 The revolution in the use of locking plate technology has now extended to the proximal humerus and site-specific locking plates have largely superseded conventional plate fixation in the last 10 years.…”