Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH).

Abstract

Decision-making in the treatment of proximal humeral fractures is generally based on individual parameters such as the biological age and activity level of the patient, the quality of bone, and specific fracture parameters such as the degrees of displacement and instability1,2. Nondisplaced fractures and fractures with minimal displacement and adequate stability are usually successfully treated nonoperatively1-3. There is a certain consensus that displaced four-part fractures with a high degree of comminution, fracture-dislocations, and head-splitting fractures in the elderly should be treated with primary hemiarthroplasty1-4. However, the recommendations for the treatment of displaced three or four-part fractures of the proximal part of the humerus remain controversial1-3. A variety of treatment techniques has been proposed, and a wide range of functional outcomes has been reported5-22. An extended exposure of the fracture elements and the use of bulky hardware for internal fixation may increase the risk of osteonecrosis of the humeral head2,15-17 and may provoke a variety of complications such as subacromial impingement or screw and plate loosening due to poor bone stock. Therefore, minimally invasive techniques combining indirect reduction of the fracture and percutaneous screw fixation and cerclage or tension-band wiring have been advocated to preserve the soft-tissue envelope and the blood supply to the humeral head10,11,15,17-21. However, these techniques do not necessarily lead to better functional results than nonoperative treatment does, especially in elderly patients with osteoporosis23. Previously, intramedullary nailing as a therapeutic alternative was limited to retrograde elastic nailing, which often does not secure rotational stability of the humeral head19-21. More recently, treatment with several types of antegrade interlocking …