PROXIMAL HUMERAL FRACTURES TREATED BY ANTEGRADE NAILING

Abstract

In a prospective study, we reviewed 23 proximal humeral fractures treated by AO/Synthes intramedullary nailing between January 1999 and December 2000.

According to Neer’s classification, there were 12 two-part fractures, eight three-part and three four-part fractures. There was anterior dislocation of the glenohumeral joint in four patients. The mean age of the 16 men and seven women was 49 years (26 to 71). More fractures occurred in patients over 55 years of age. Anteroposterior and trans-scapular radiographs were taken and CT routinely performed. Surgery was performed within 5 to 14 days of injury. In young patients with two-part fractures, we used percutaneous integrate nailing. Three and four-part fractures were reduced and fixed through a short anterolateral deltoid split approach. The nail was inserted without reaming. The fracture fragments were reduced around the exposed proximal part of the nail and reduction secured by insertion of locking screws and a tension wire band. Ruptures of the rotator cuff were repaired. The nail was locked distally in 16 fractures.

The arm was immobilised for two or three weeks but supervised shoulder movement started as early as four to five days postoperatively. All fractures healed within 12 weeks. Functional shoulder movement returned in all but two cases. In younger patients recovery was faster and a near-full range of abduction and flexion returned. No sepsis occurred. Postoperative backing-out of the nail and varus deformity of the humeral head occurred in two patients. Two patients required re-operation. Backing-out of proximal locking screws was observed but did not affect functional outcome.

This minimally-invasive method of fixation by intramedullary nail, locking screws and tension wire band through a short incision may be an alternative way of managing complex proximal humeral fractures.