Abstract
Displaced proximal humeral fractures remain a difficult management problem. There are many treatment methods described in the literature but there is no universally accepted technique.
Materials and Methods We treated 25 patients with displaced fractures of the proximal humerus by internal fixation with a locked Polarus nail at our hospital over a period of 4 years. The male: female ratio was 13:12. The average age was 63 yrs and the average follow-up in the series was 24 months. Fracture union was evaluated by regular clinical and radio graphic examination. The functional outcome was assessed by Constant’s score.
Results In 23 patients, the fracture united while one patient had failure of the proximal fixation due to collapse of the head requiring a shoulder replacement. One patient died post-operatively due to medical conditions. There were no wound infections in our series; two patients had temporary radial nerve palsy. There were three patients in which one of the proximal locking screws was missing the nail. There was backing out of proximal locking screws in four patients which required removal. One patient required removal of the nail due to impingement symptoms. There was no difference in the Constant’s score in the young and the elderly population. 75% of the patient’s were satisfied with their functional outcome.
Discussion In our limited experience, Polarus nail is an effective mechanical device for the treatment of unstable proximal humeral fractures. The proximal locking screws are often seen to back out in elderly population and they may require removal if symptomatic. This appears to be due to poor grip of screws in osteoporotic bone. In order to minimise the risk of proximal screws missing the nail we recommend the nail insertion device should be assembled by the surgeon himself before insertion into the patient and check to make sure the holes in the jig match those in the nail. In our hands we found that the entry point is very critical and we feel that it should be as medial as possible to preserve the lateral metaphysis. Our study shows that Polarus nail is an effective device to treat displaced proximal humeral fractures but the fracture communition and bone quality also plays a role in the outcome of such fractures.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
