The purpose of this study is the assessment of the shoulder function after a proximal humeral nail insertion for trauma, using a minimal invasive approach.

Material and methods: 22 patients had osteosynthesis for proximal humeral fractures using the Telegraph Nail. 15 patients underwent percutaneous osteosynthesis. The indication for the percutaneous procedure was determined at the per-operative control under fluoroscopy when the fracture was reducible by external manoeuvres. 12 of the fractures involved the surgical neck and 3 fractures were three-part fractures of the proximal humerus. The proximal interlocking was made using two screws in all the cases. The distal static interlocking was made with a single screw in all the cases.

All the patients followed a standardised rehabilitation protocol including early mobilisation and passive and active assisted muscular activity. The shoulder function was assessed using the Simple Shoulder Test (SST) and the Constant score. The mobility was assessed using the flexibility ratio described by Harryman as compared to the opposite healthy arm. The patients were assessed at 6, 12, 26 and 52 weeks after surgery.

Results: All the fractures showed consolidation within 6 weeks. Two fractures united with internal rotation and presented at controls with limited external rotation. Stable results were obtained at an average of 3 months. Return to previous activities was possible between 8 and 10 weeks after surgery in all the cases excepting two. In one case subacromial conflict between the nail and the rotator cuff was due to malpositioning of the proximal part of the nail and of the screws and required early removal and cuff repair. Average forward elevation was 12O25. Average external rotation was 4515. The SST score reached an average of 8.2/12 within 6 months and practically was unchanged at 12 months for all the series. The pondered Constant score was 76.7/1OO at six months. All the patients were improved after surgery.

Conclusion and discussion: The percutaneous insertion of a proximal humeral nail for shoulder fractures is a minimally invasive alternative to heavy open surgery. The results are acceptable for the patients and stable in time. The advantage of minimal bleeding and short hospital stay recommend this technique in all the cases when reduction is possible without opening, as showed by the fluoroscopy.