Minimally Invasive Osteosynthesis in Elderly Osteoporotic Proximal Humerus Fractures Using J-Nailing Technique

Abstract

Abstract Introduction Proximal humerus fractures in the osteoporotic elderly population are increasing and difficult to treat. Treatment in proximal fracture fixation in elderly has changed from absolute stability to relative stability that preserves soft tissue and vascularity, thereby improving clinical outcomes. Aims and Objectives This study aimed to evaluate the clinical outcome of proximal humerus fractures in osteoporotic patients using minimally invasive J-nailing technique. Methods and Materials A prospective observational study was done on 25 patients with proximal humerus fractures belonging to Neer's classification type 2 and 3 operated between May 2018 and June 2020 in the department of orthopaedics in tertiary health care center and treated by multiple intramedullary blunt Kirschner wires (J-nailing technique). The patients were followed up at 2, 6, 12, and 36 weeks. At the end of follow-up, clinical outcome was assessed using Neer's scoring system. Results Treatment of proximal humerus fractures with J-nailing technique in the elderly population has shown promising results both in terms of function and radiology. Mean union time was 13.48 weeks with a standard deviation of 1.19 weeks. We did not find any significant difference in union time between patients with fracture type 2-part and 3-part. However, there was a significant difference in Neer's scoring between patients with fracture types two-part and three-part. Conclusion Proximal humerus fracture fixation using minimally invasive techniques with J-nailing is an effective method of stabilization in elderly osteoporotic population, yielding good mechanical alignment, protecting rotator cuff muscles, preserving blood supply and predictable union rates with good clinical results.