A new nail with a locking blade for complex proximal humeral fractures.

F R Hashmi,Edgar Mayr

doi:10.1007/s00590-016-1817-4

Abstract

IntroductionThe objective of this study was to assess the clinical outcome of displaced proximal humerus fracture treated with a new locking blade nail.Materials and methodsThis prospective study included a series of 92 patients with acute fracture of the proximal humerus treated in one hospital level I trauma centre with locking blade nail between December 2010 and December 2013. According to the Neer classification, all fractures were two- to four-part fractures. Age adopted Constant score, DASH and visual analogue scores were used as outcome measures.ResultsA total of 92 patients were enrolled in the study. However, 29 patients were excluded due to loss to follow-up and death. Ultimately, 63 patients were available for final follow-up and data analysis. The mean duration of follow-up was 22 months (range 16–48 months). On average at 1 year, all fractures had united. The mean weighted Constant score was 84.2 % and the median disabilities of the arm, shoulder and hand (DASH) score was 26, the range of elevation was 115 and range of abduction was 97. The head shaft angle was 130, and pain visual analogue was 1.6. We found that 5 of the 63 patients (8 %) demonstrated complications. Two patients (3 %) displayed secondary displacement and require device removal. Two patients (3 %) had impingement due to prominent metal work, and one patient had a superficial wound infection which was treated with a course of antibiotics.ConclusionOur study shows excellent results with new locking blade nail for displaced proximal humerus fractures. We think the locking blade nail offers stiff triangular fixation of the head fragment and support of the medial calcar region to prevent secondary varus collapse.Level of evidenceIII.

Highlights

Introduction The objective of this study was to assess the clinical outcome of displaced proximal humerus fracture treated with a new locking blade nail
Materials and methods This prospective study included a series of 92 patients with acute fracture of the proximal humerus treated in one hospital level I trauma centre with locking blade nail between December 2010 and December 2013
Age adopted Constant score, DASH and visual analogue scores were used as outcome measures

Summary

Introduction

The objective of this study was to assess the clinical outcome of displaced proximal humerus fracture treated with a new locking blade nail. Two patients (3 %) had impingement due Keywords Proximal humeral fractures Á Locked blade Á Functional outcome Á Insufficient primary stability Á Calcar Á Rotator cuff Á Minimal soft tissue damage Á Triangular fixation Á Outcome measures. The management of proximal humeral fractures is challenging These fractures pose a problem for choosing the best management modality, especially to preserve bone alignment and joint surface congruity and yet maintain the vascularity of the humeral head. This is especially the case with complex fractures, where there is a significant complication rate; they are managed. Conservative management has a role in un-displaced and minimally displaced fractures but shows consistently inferior results in terms of pain relief and return of functional range of motion [4, 5]

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