Treatment of proximal humeral fractures with a new intramedullary nail

We have developed a new intramedullary nail (All-in-One Nail) that is specifically designed for elastic fixation of a surgical neck fracture of the humerus. This nail has three pins and a plate, and the pins become divergent as the nail is inserted into the marrow cavity through the deltoid tuberosity and then advanced to the humeral head. We reviewed 31 patients with an age range of 58–91 years (mean 75 years) who underwent surgery with this nail for A3.2 (two-part), B2.2 (three-part), or C2.1 (valgus-impacted) fractures of the proximal humerus. Bony union was obtained in 29 patients, and these patients had a Japanese Orthopaedic Association shoulder score of 60–92 (mean 78) in a follow-up examination performed 6–32 months (mean 13 months) postoperatively. The All-in-One Nail system is easy to use, provides an acceptable clinical outcome, and is a treatment option for unimpacted surgical neck fractures and valgus-impacted fractures of the humerus.     

Surgical treatment of sequelae of fractures of the proximal third of the humerus. The role of osteotomies

Between 1996 and 2003 a total of 19 humeral head osteotomies were performed to treat post-traumatic malunion of the proximal humerus. Mean age was 46 years, ranging from 17 to 71 years. The period of time between traumas and surgeries ranged from 6 to 22 months. Osteotomy procedure was as follows: one after two-part fracture of the greater tuberosity, three after two-part fracture of the surgical neck, five after three-part fracture of the greater tuberosity, eight after four-part fracture, two after complex head splitting fracture, one after two-part fracture with anterior dislocation. Three different types of osteotomies were performed: osteotomy of the humeral neck for varus deformity, isolated osteotomy of the greater tuberosity, and a new osteotomy technique (two-plane and three-plane osteotomy) for three- and four-fragment fracture sequelae. At the time of follow-up evaluation, all 19 patients were questioned regarding pain and function. Excellent results in 14 patients and satisfactory results in 5 were obtained. None of the patients required revision surgery. Findings were recorded using the Constant rating scale. All patients had had significant pain relief after shoulder osteotomy. Range of motion was increased in all patients treated by osteotomy. The success of osteotomy in these cases was based on: patient selection, extensive preoperative evaluation, surgical technique and postoperative rehabilitation.     

Percutaneous fixation with Schanz screws for displaced two- and three- part fractures of the proximal humerus in patients above fifty years of age

Purpose:

The aim of this study is to evaluate whether two 3.0 mm Schanz screws in two-part proximal humeral fractures (plus one additional Schanz screw or K wire in three-part fractures) can provide enough stability to allow early mobilization until healing occurs in elderly patients.

Settings and Design:

This prospective study was performed in the Orthopaedic Department of our University Hospital.

Patients and Methods:

We performed closed reduction and percutaneous pinning for thirty-three patients with proximal humerus fractures. Twenty-seven patients were available for the final follow-up. Of those 27 patients, 17 had two-part surgical neck fractures; while 10 had three-part fractures. For fixation, we used two 3.0 mm Schanz screws in patients with two-part fractures plus one additional Schanz screw or K wire in the 10 patients with three-part fractures.

Results:

The mean Constant score modified according to the age and sex was 89.8% (range: 77.3-97.2%). Fifteen patients had excellent results, 11 patients had good results, and one patient had a fair result.

Conclusion:

Closed reduction and percutaneous pinning with two Schanz screws for two-part surgical neck humeral fractures, plus an additional Schanz screw or K wire for three-part proximal humeral fractures is a useful and effective technique that provides enough stability to allow an early rehabilitation program till union occurs in elderly patients.

Level of Evidence:

IV; therapeutic study, case series.     

Open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus

Twenty-two patients aged 20 to 82 years (average 56 years) were followed for 1.1 to 8.9 years (average 3.3 years) after open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus. There were 14 two-part displaced surgical neck fractures, seven three-part displaced greater tuberosity and surgical neck fractures, and one three-part displaced lesser tuberosity and surgical neck fracture. Fixation was achieved with heavy nonabsorbable sutures or wire that incorporated the rotator cuff tendons, tuberosities, and shaft. In cases with significant surgical neck comminution, humeral Enders nails were incorporated in a tension-band construct to provide longitudinal stability. Eighteen (82%) of the 22 patients had good or excellent results. Three (14%) of the 22 had satisfactory results, and one (5%) had an unsatisfactory result. The use of a technique of limited internal fixation for these displaced fractures without the use of plates and screws achieved fracture stability and a high percentage of acceptable results.     

肱骨近端"头帽型"骨折的解剖学特点及诊疗方案研究

目的探索适合肱骨近端特殊类型的"头帽型"骨折的诊疗方案，降低术后并发症的发生率。 方法根据骨折的影像学分型、解剖学特点及术后并发症的发生率，结合北京大学人民医院创伤骨科2016年1月至2017年12月诊治的肱骨近端"头帽型"骨折患者18例诊疗结果，研究肱骨近端"头帽型"骨折的诊疗特殊性。 结果符合肱骨近端"头帽型"骨折分型的18例中9例采取切开复位钢板内固定手术治疗，有2例（22%）出现了不同程度的肱骨头吸收、肱骨头骨块厚度变薄和预后肩关节活动功能差；而采取人工关节置换术的9例未出现预后肩关节活动受限等并发症。 结论"头帽型"骨折术后发生肱骨头坏死、畸形愈合等风险高，应高度重视该骨折类型固定的特殊性。     

213例肱骨近端骨折的Neer分型

目的 探讨Neer分型的临床应用.方法 对自2003年3月至2010年7月我科收治的213例肱骨近端骨折患者的资料进行分析.根据术前X线片进行Neer分型,并与原始诊断对比,有疑问的病例通过讨论得到统一结论.结果 213例骨折中,有65例(30.5%)两部分外科颈骨折(含骨折脱位),51例(23.9%)两部分大结节骨折(含骨折脱位),1例(0.5%)两部分解剖颈骨折,40例(18.8%)三部分外科颈大结节骨折(含骨折脱位),33例(15.5%)典型四部分骨折(含骨折脱位),16例(7.5%)外展嵌插型四部分骨折,5例(2.3%)头劈裂骨折和2例(0.9%)头压缩骨折.前后诊断对比发现:对于两部分骨折的诊断,此次阅片与入院时较一致;对于三部分及以上骨折,前后两次阅片差别较大.结论 严格按照Neer分型的定义,并借助特殊影像学方法,绝大多数骨折可以很好地进行Neer分型.

Abstract：

Objective To discuss application and limitation of Neer classification of proximal humeral fractures (PHF) in clinic. Methods We reviewed the clinical data of 213 PHF patients who had been treated in our department between March 2003 and July 2010.Using Neer classification system,we reclassified the fractures and compared with the original Neer classification results according to the radiographic images taken just before operation.For difficult cases,consensus was reached after discussion. Results Of the total cases,there were 65 (30.5％) two-part surgical neck fractures,51 (23.9％) two-part great tuberosity fractures and one (0.5％) two-part anatomical neck fracture,40 (18.8％) three-part fractures involving the greater tuberosity and the surgical neck,33 (15.5％) four-part fractures,and 16 (7.5％) four-part valgus-impacted fractures,5 (2.3％ )head-split fractures and 2 (0.9％ ) head-compression fractures.Comparison of the Neer classifications revealed that for two-part fractures the agreement between the 2 diagnoses was high and that for three-above-part fractures there was great difference between the 2 diagnoses. Conclusion With proper aid of radiographic images,Neer classification can result in a precise diagnosis of most fractures of proximal humerus but not in all.     

Internal fixation of proximal humerus fractures using the T2-proximal humeral nail

Introduction

Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Created to improve previous designs, the T2-proximal humeral nail (PHN) (Stryker^®) has been recently released, and the English literature lacks a series evaluating its results. We present a clinical prospective study evaluating this implant for proximal humeral fractures.

Method

We evaluated the functional and radiological results and possible complications. Twenty-nine patients with displaced fractures of the proximal humerus were treated with this nail. One patient was lost right after surgery and excluded from the assessment. Eighteen patients were older than 70 years.

Results

There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

     

Two-part and three-part fractures of the proximal humerus treated with suture fixation

OBJECTIVE: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with nonabsorbable rotator cuff-incorporating sutures. DESIGN: Retrospective. SETTING: University hospital. PATIENTS: There were 27 patients (28 shoulders) with displaced proximal humerus fractures. There were 13 greater tuberosity (GT) and 9 surgical neck (SN) two-part fractures and 6 GT/SN three-part fractures. The average age was 64 years (range 38 to 84 years). The average follow-up was 4.4 years (range 1.0 to 11.5 years). INTERVENTION: All patients were surgically treated solely with heavy polyester nonabsorbable sutures. MAIN OUTCOME MEASUREMENTS: Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score and Neer's criteria, which grade outcomes as excellent, satisfactory, or unsatisfactory. RESULTS: Overall, there were 22 (78%) excellent, 3 (11%) satisfactory, and 3 (11%) unsatisfactory results, and the average ASES score was 87.1 (range 35.0 to 100.0). All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. Twenty-four shoulders (86%) had anatomic alignment on postoperative radiographs. Of four shoulders with nonanatomic alignment, three had ASES scores of >/=90, with excellent Neer scores. When comparing patients with isolated two-part GT fractures (n = 13) with patients having two-part SN or three-part SN/GT fractures (n = 15), there were no statistically significant differences with respect to range of motion (P > 0.05) and outcome measures (P > 0.05). All patients who had unsatisfactory outcomes were noncompliant with physical therapy, with ASES scores averaging 39.4 (range 35.0 to 43.3). CONCLUSION: Two-part and three-part GT and SN fractures can be treated satisfactorily with heavy nonabsorbable rotator cuff-incorporating sutures, particularly in elderly patients. Hardware-associated complications are obviated. Patients with SN fractures treated with sutures can have outcomes similar to patients with two-part GT fractures. Although the goal is to reconstruct a "one-part" fracture pattern, some residual deformity does not preclude an excellent outcome. A compliant patient is crucial for a successful result.     

Morphological Analysis of Fractures of the Proximal Humerus by the Fracture Mapping Technique

Objective

Fractures of different parts of the proximal humerus may lead to different postoperative functional deficits, but there are few studies on the morphology and related functions of the proximal humerus. The purpose of this study was to analyze the fracture pattern of the proximal humerus by the three-dimensional (3-D) fracture mapping technique and to further evaluate its clinical utility.

Methods

Patients with proximal humeral fractures admitted to Pudong Hospital, Fudan University, from January 2018 to December 2020, were analyzed. Three surgeons divided the fractures into groups according to the 3-D CT imaging technique and mapped the fractures on a 3-D template according to the fracture line of each fracture. Finally, the humeral head inversion angle and the functional score were recorded in different fracture types.

Results

A total of 312 cases of humeral fractures were included. Among them, there were 90 patients (28.8%) in the simple greater tuberosity + lesser tuberosity + medial cortex group, with typical fracture features of surgical neck fractures of the humerus + greater tuberosity fractures. Eighty-seven patients (27.9%) in the greater tuberosity + isolated fragment lesser tuberosity + medial cortex group had typical “four-part fractures.” There were 45 patients (14.4%) in the greater tuberosity + lesser tuberosity + medial isolated fragment group. Moreover, more patients in this group had medial comminution due to varus displacement of the femoral head. There were 66 patients (21.1%) in the isolated greater tuberosity group, 21 patients (6.7%) in the greater tuberosity + lesser tuberosity group, and three patients (1.0%) in the greater tuberosity + medial cortex group. In addition, the humeral head inversion angle and other statistical differences were observed in the greater tuberosity + lesser tuberosity + medial isolated fragment group.

Conclusions

This morphological study helps to further identify the characteristics of proximal humerus fracture patterns, which may be closely related to different clinical outcomes. Further relevant studies are needed to verify the reliability of their clinical application and the potential value in surgical planning and postoperative functional rehabilitation.     

Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques

BACKGROUND: Successful internal fixation of fractures of the surgical neck of the humerus can be difficult to achieve because of osteopenia of the proximal aspect of the humerus. The purpose of this study was to compare the biomechanical stability of a proximal humeral intramedullary nail and a locking plate for the treatment of a comminuted two-part fracture of the surgical neck in a human cadaver model. METHODS: Twenty-four cadaveric humeri were instrumented with use of either a titanium proximal humeral nail (PHN) or a 3.5-mm locking compression plate for the proximal part of the humerus (LCP-PH). The specimens were matched by bone mineral density and were separated into four experimental groups with six humeri in each: PHN bending, LCP-PH bending, PHN torsion, or LCP-PH torsion. Comminuted fractures of the surgical neck were simulated by excising a 10-mm wedge of bone. Bending specimens were cyclically loaded from 0 to 7.5 Nm of varus bending moment at the fracture site. Torsion specimens were cyclically loaded to +/-2 Nm of axial torque. The mean and maximum displacement in bending, mean and maximum angular rotation in torsion, and stiffness of the bone-implant constructs were compared. RESULTS: In bending, the LCP-PH group demonstrated significantly less mean displacement of the distal fragment than did the PHN group over 5000 cycles (p = 0.002). In torsion, the LCP-PH group demonstrated significantly less mean angular rotation than did the PHN group over 5000 cycles (p = 0.04). A significant number of specimens in the PHN group failed prior to reaching 5000 cycles (p = 0.04). The LCP-PH implant created a significantly stiffer bone-implant construct than did the PHN implant (p = 0.007). CONCLUSIONS: The LCP proximal humeral plate demonstrated superior biomechanical characteristics compared with the proximal humeral nail when tested cyclically in both cantilevered varus bending and torsion. The rate of early failure of the proximal humeral nail could reflect the high moment transmitted to the locking proximal screw-bone interface in this implant. CLINICAL RELEVANCE: The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor.     

Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning

Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality, comminution, and the deforming forces of the rotator cuff on the tuberosities influence the choice of operative approach and fixation techniques. Closed reductions and percutaneous pinning offer the potential advantage of minimal soft-tissue dissection; however, good bone quality and minimal comminution are prerequisites. Selected two-part surgical neck fractures and valgus-impacted fractures lend themselves well to this technique. Open reduction and internal fixation is indicated in two-part surgical neck fractures with poor bone quality or extensive comminution, two-part greater tuberosity or lesser tuberosity fractures, and most three-part fractures. The choice of surgical approach is dictated by the fracture pattern and includes an extended deltopectoral approach and a superior deltoid-splitting approach. Fixation techniques are myriad and are dependent on the fracture pattern. Potential fixation methods include intramedullary rods, interfragmentary sutures or wires, and extramedullary plates and screws or blade plates. Successful results are predicated on obtaining adequate enough fixation to allow early passive motion. Results also are influenced by the quality of the reduction and patient compliance.     

解剖锁定钢板结合注射式人工骨植骨治疗老年肱骨近端外展嵌插四部分骨折

目的探讨解剖锁定钢板结合注射式人工骨植骨治疗老年肱骨近端外展嵌插四部分骨折的疗效。 方法回顾性分析2014年7月至2018年5月复旦大学附属浦东医院采用解剖锁定钢板结合注射式人工骨植骨治疗的11例老年肱骨近端外展嵌插四部分骨折患者的病例资料,其中男性4例、女性7例;平均年龄72岁。评估术后情况、肩关节功能及术后并发症。 结果末次随访时,患者视觉模拟评分平均1.6分;多数患者肩关节功能恢复良好,肩关节活动范围：平均前屈角度166°,平均外展角度166°;平均Constant-Murley评分为86.2分;前臂、肩及手快速残疾调查评分平均18.9分。随访过程中无病例出现肱骨头缺血性坏死、螺钉切出或其他内固定失败。 结论注射式人工骨植骨一方面填塞外展嵌插复位后造成的骨缺损,另一方面提高螺钉的把持力,可有效解决近端螺钉切出的问题,解剖锁定钢板结合注射式人工骨植骨是治疗老年肱骨近端外展嵌插四部分骨折的有效选择。     

闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折

目的：通过分析28例闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折的临床疗效，探讨治疗体会及教训。方法：2005年11月至2006年11月采用闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折28例，男12例，女16例；年龄31-73岁，平均54．7岁。均为新鲜骨折。骨折根据Neer分型：两部分外科颈骨折18例，外展嵌插两部分大结节骨折10例。结果：本组平均手术时间42min,口均Ⅰ期愈合，X线片显示骨折对位满意，向前成角基本矫正。外展嵌插两部分大结节骨折的颈干角从术前的平均175°（160°-200°）恢复至平均136°（128°～142°），大结节移位小于3mm。随访6-13个月，平均10．3个月，骨折均愈合，未出现肱骨头缺血坏死现象，术后8—10周取出内固定。根据ASES及Constant-Murley肩关节评分系统，本组ASES评分平均91．2分（63～100分），Constant—Mudey评分平均90．4分（67-100分）。本组优12例，良14例，一般2例。结论：闭合或有限切开经皮穿针固定治疗肱骨近端两部分骨折的操作有相当难度，且须在透视下进行，但具有损伤小、康复快的优点，是治疗特定类型肱骨近端骨折的有效方法。骨质情况是决定固定稳定程度的必要条件。     

应用小切口PHILOS钢板治疗肱骨近端骨折效果评价

[目的]探讨PHILOS钢板有限切开治疗肱骨近端骨折的方法与疗效。[方法]应用PHILOS肱骨近端解剖型钢板有限切开(肱骨近端前外侧入路)治疗肱骨近端骨折54例。其中男31例,女23例,年龄48～79岁,平均62岁。根据Neer分型二部分骨折19例(解剖颈骨折9例,外科颈骨折8例,大结节骨折2例);三部分骨折25例;四部分骨折10例(骨折伴肩关节脱位2例)。[结果]54例患者经18个月的随访,54例均愈合,影像学提示骨愈合发生在10周左右,有1例发生轻度肩峰撞击,1例四部分骨折的患者发生部分肱骨头坏死。根据术后肩关节Neer评分法,优27例,良23例,可4例,优良率达92.6%。[结论]肱骨近端骨折应用PHILOS钢板固定,重视内侧皮质复位内侧柱的重建,手术创伤小,复位简便,骨折愈合顺利,肩关节功能恢复好,未发现术后明显复位丢失、钉板松动和断裂病例,为目前治疗肱骨近端骨折的较理想的方法。     

Fixation of proximal humeral fractures with the Polarus nail

Thirty patients with fractures of the proximal humerus were treated by internal fixation with an intramedullary locked nail. Fourteen of these patients were more than 60 years of age; 23 patients had 2-part fractures (surgical neck fractures) and were operated on within an average of 3 days after injury. At follow-up, 20 (80%) of 25 patients showed satisfactory to excellent functional outcomes, as measured by Constant score. All but 1 fracture progressed to clinical and radiologic union. The good functional results indicate that the Polarus nail is a satisfactory mechanical device that can be used in the treatment of displaced proximal humeral fractures in both the young and the elderly with osteopenic bone.     

交锁髓内钉治疗肱骨近端骨折

目的探讨肱骨近端交锁髓内钉治疗肱骨外科颈骨折临床效果。方法应用肱骨近端交锁髓内钉治疗14例肱骨近端二部分外科颈骨折和9例三部分大结节骨折患者。结果患者均获随访,时间12~28个月,骨折均骨性愈合。按照Constant-Murley肩关节评分标准评价为65~95分,其中优12例,良7例,一般4例。结论应用肱骨近端交锁髓内钉治疗肱骨近端二部分外科颈骨折和三部分大结节骨折,减少了软组织损伤,可早期行关节功能锻炼,是一种安全有效治疗方法。     

应用肱骨近端锁定型髓内针治疗肱骨近端骨折的临床疗效分析

目的探讨应用肱骨近端髓内针治疗肱骨近端两部分外科颈骨折的疗效。方法回顾性分析22例应用锁定型肱骨近端髓内针治疗两部分外科颈新鲜骨折患者的临床资料,患者平均年龄57岁。最终随访时拍摄肩关节X线片以评价愈合情况,并应用可视模拟评分法（VAS）评分,美国肩肘外科医师评分（ASES）,Constant-Murley评分,UCLA评分以及简易肩关节测验（SST）问卷评估。结果所有患者均获随访,平均随访时间为13个月,22例患者骨折均在术后8周内初步愈合。随访过程中未出现感染、肱骨头坏死以及任何与内固定物有关的并发症。术后患肢主动前屈上举平均为147．8°,主动体侧外旋平均为45．5°,主动内旋平均达T10水平。术后患者疼痛VAS评分平均为1．5。平均ASES评分为81．2,Constant-Murley评分为85．4,UCLA评分为29．9,SST评分为9．5。18例患者的肩关节功能评估为优或良,4例患者肩关节功能评估为差。结论闭合复位、锁定型肱骨近端髓内针固定术是治疗肱骨近端两部分外科颈骨折的一种有效的手术方式。     

A preliminary clinical experience with Polarus nail for proximal humeral fractures. A pilot study on ten patients

The Polarus nail has recently been popularised to fix proximal humeral fractures. In the current pilot study we reviewed the early results obtained using this nail. Ten patients with proximal humeral fracture (four pathological, 5 traumatic and one non-union) were fixed using a Polarus nail. The fractures were classified according to Neer (7 two-parts and 3 three-part fractures). The mean followup was 22 months (6–39) months. The following criteria were assessed: pain, range of shoulder movement and function. Seven patients were satisfied with their operation, their fractures healed in a mean period of 3 months (2–4 months). No postoperative neurovascular complications were encountered; the re-operation rate, was however 30%. Conclusion: in the authors' brief pilot study in 10 patients, and despite the heterogenous fracture types, we came in to conclusion that the indications for using Polarus nail is limited due to the high complications rate associated with the procedure when used for displaced three or four part surgical neck fracture of humerus.     

A new approach for the treatment of proximal humeral fractures using the TRIGEN proximal humeral nail

The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial. One of the new treatment options is the minimally invasive intramedullary nail. The purpose of this study was to evaluate the functional outcome of using the TRIGEN proximal humeral nail (PHN) for the treatment of displaced proximal humeral fractures in elderly patients. From January 2004 to December 2008, 64 elderly patients (age > 60 years old) with displaced proximal humeral fractures were treated using TRIGEN PHN. A complete 12-month postoperative follow-up was available for 54 patients. The study cohort included two-part (29 shoulders), three-part (22 shoulders), and four-part (3 shoulders) Neer classification fracture types. The Constant-Murley score was used to assess functional outcome. Radiological outcomes were evaluated, and all complications were recorded. All fractures were united. The Constant-Murley score data indicated that the patients experienced improvement from 6 to 12 months postoperatively. The mean absolute Constant-Murley score on the injured side increased from 71.2 ± 11.2 points at 6 months to 82.4 ± 16.4 points at 12 months (P = 0.01). The mean neck-shaft angle 1 year after surgery was 125° ± 8.1° (95°–140°). Secondary complications were minimal and observed in only 6 of 54 patients. In conclusion, the TRIGEN intramedullary humeral nail is effective for the treatment of proximal humeral fractures.     

Locking plate fixation for proximal humerus fractures

Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.