Antegrade intramedullary nailing in proximal humeral fractures: results of 23 cases

Abstract

Introduction: the metaepiphyseal fractures of the proximal humerus represent 5% of all fractures and mainly affect elderly patients. The type of treatment remain controversial. This retrospective study aimed to evaluate the clinic and radiographic results of 23 patients affected by two or three fragments fractures of the proximal humerus with or without metaphyseal extension treated with antegrade intramedullary nailing.

Materials and methods: all patients were clinically evaluated using the "Constant score" (CS) and individual satisfaction was assessed with a visual scale (VS). Moreover, the fracture's healing process and the neck shaft angle (NSA) were assessed radiographically.

Results: the mean follow-up was 72 months (24-120). Clinical evaluation and individual satisfaction were positive in most cases (mean CS 79,39 and VS 3,17). Worse results were observed in patients over 65 years.

Discussion: among the different surgical options intramedullary nailing ensures good fracture stability and high consolidation rate. The entry point through the rotator cuff is of main importance as well as proximal nail positioning and choice of the locking screws length. In this study the functional results of the shoulder are worse in the elderly, who are supposed to have already a degenerated rotator cuff.

Conclusions: antegrade intramedullary nailing should be considered a valid therapeutic option in this type of fractures. The surgical technique may influence functional results, as consequence of iatrogenic damage of the rotator cuff.

Figure 1.

Distribution of CS in both arms

Figure 2.

T test of CS without statistically significative differences

Figure 3.

Wilcoxon-Mann-Whitney test without differences of CS

Figure 4.

Pearson Correlation Index with correlation between CS and age