Clinical Application of Nail-Plate Fixation in the Treatment of Complex Proximal Third Humeral Fracture: A Case Report and Literature Review

Abstract

Background: Proximal humeral fractures with increasing incidence are common over the past decades. Among them, the complicated and displaced ones, especially combined with the proximal third humeral shaft fractures, need to be treated surgically. Humeral intramedullary nail and locking plate are the most frequently used options. However, few studies address the application of nail-plate combination for management.

Case presentation: A 49-year-old man struck by a car was referred to our emergency trauma center. The X-ray and three-dimensional computed tomography (CT) showed a complex proximal humeral fracture with proximal third shaft fracture. No evidence of other associated injuries and neurovascular symptom of the injured left upper limb was shown by physical examination. Nail-plate fixation was performed to restore the anatomic integrity of proximal humerus. The injured arm was maintained in a broad arm sling for 14 days after surgery. The active as well as positive movements under the instruction were encouraged as long as the pain could be tolerated from postoperative day 2. One year after the surgery, the fracture was healed, and the patient regained normal shoulder motion. The good clinical outcomes were obtained by application of nail-plate fixation to treat complex proximal third humeral shaft fractures. Thus, this surgical intervention could be performed as an alternative.

Keywords: Clinical application; Clinical outcomes; Complex fracture; Nail-plate fixation; Proximal humerus fracture.

Fig. 1

(A) Preoperative anteroposterior X‐ray view demonstrated a comminuted proximal humerus fracture. (B) Three‐dimensional CT showed a comminuted proximal humerus fracture. (C) The vascular imaging of comminuted proximal humerus fracture preoperatively

Fig. 2

K‐wires were employed for temporary fixation of the proximal humerus fracture; the guide pin was inserted

Fig. 3

(A) Anteroposterior X‐ray view of the humerus demonstrated maintained reduction with nail and plate construct. (B) Internal rotation X‐ray view showed satisfactory reduction with nail and plate construct

Fig. 4

(A)Anteroposterior X‐ray view displayed the healed proximal humeral fracture postoperatively. (B) Internal rotation X‐ray view revealed the healed proximal humeral fracture postoperatively. (C) Axillary X‐ray view displayed the healed proximal humeral fracture postoperatively

Fig. 5

(A) Patient's active range of motion during follow‐up (shoulder abduction). (B) Patient's active range of motion during follow‐up (shoulder flexion)