Intramedullary nailing of displaced four-part fractures of the proximal humerus
•Intramedullary nailing can be safely used for the treatment of four-part fractures of proximal humerus.•Clinical outcome of intramedullary nailing of displaced four-part fractures is similar to osteosynthesis with locking plates.•Appropriate reduction of fracture fragments is the key for good funct...
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| Published in: | Injury Vol. 50; no. 11; pp. 1978 - 1985 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Netherlands
Elsevier Ltd
01-11-2019
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •Intramedullary nailing can be safely used for the treatment of four-part fractures of proximal humerus.•Clinical outcome of intramedullary nailing of displaced four-part fractures is similar to osteosynthesis with locking plates.•Appropriate reduction of fracture fragments is the key for good functional result.•Our study analyses largest published cohort of the patients with displaced four-part fracture treated by intramedullary nail.
Intramedullary nailing is already established technique for the treatment of two and three-part fractures of proximal humerus. The aim of the study was to prospectively evaluate the efficacy and functional outcome after treatment of four-part fractures of proximal humerus with Multiloc proximal humeral nail.
prospective monocentric cohort study.
single level 1 traumacenter.
From February 2011 to March 2016, 40 patients with displaced four-part proximal humeral fractures were treated with intramedullary nail inserted through anterolateral approach. Minimum one year follow up completed 35 patients and were involved into the study.
After mean follow up period of 25.8 months 29 of 35 fractures healed. Average absolute Constant score in all 35 patients reached 57.7 points, relative side related Constants score 66.8% of contralateral extremity. Together there were 20 complications. in 6 cases (17%) developed complete avascular necrosis of the head. One deep infection was treated by implantation of antibiotic cement discs. Twelve secondary surgeries were performed, mostly for avascular necrosis development. Function and pain were significantly influenced by the quality of fracture reduction (p < 0.05) and development of complete AVN (p = 0.001). Group of 29 patients without AVN reached relative Constant score 73% of contralateral extremity.
Intramedullary nailing can be used as possible fixation technique for the treatment of four-part fractures of proximal humerus. In experienced hands provides nailing osteosynthesis similar results as reconstruction with locking plates. Appropriate reduction of fracture fragments is the key for good functional result.
Level 2b – monocentric prospective cohort study. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0020-1383 1879-0267 |
| DOI: | 10.1016/j.injury.2019.06.029 |