Komplikationen der Nagelosteosynthese am proximalen Humerus

In a prospective outcome study, 76 of 116 patients were examined 1 year after reduction and internal fixation of a dislocated humeral head fracture with an antegrade straight intramedullary nailing system using angular and sliding stable interlocking screws. Of these patients, 77% had three- or four-segment fractures according to the Neer classification. The mean absolute Constant-Murley score 1 year after trauma was 70.0±19.7 points. During the observation period, 51 complications occurred in 44 of 76 patients; of these 44 patients, only 27 required therapeutic interventions. The highest frequency of complications was apparent in those with Neer IV fractures (73.7%), while those with Neer III and Neer IV/III fractures had complication rates of 50% and 52.5%, respectively. Patients without complications showed good or excellent functional results, ranging from 78% to 96% (relative Constant-Murley score of the contralateral noninjured side). In patients with complications, the relative Constant-Murley score ranged from 51% to 65%. Despite the high complication rate, the antegrade angular and sliding stable interlocking nail can be considered effective for treating dislocated humeral head fractures. Modifications of the surgical technique for stabilizing the tubercles (additional suture cerclage fixation of fragmented tubercles) and a polyetheretherketone (PEEK) insert in the proximal segment of the nail to prevent the fixation screws from backing out can substantially decrease some of the most frequent complications.