title: Proximal humeral fractures and intramedullary nailing: Experience with a new nail system.
abstract: OBJECTIVE
  The goal of this study was to evaluate fracture healing and alignment as well as functional outcome and complication risks after internal fixation with the intramedullary proximal humeral nail (PHN). This device shows promise for applications involving the reconstruction of the humeral shaft and head with minimal soft tissue stripping and for providing a locked, fixed-angle construct for secure fixation to permit controlled, early, and active rehabilitation.
  
  
  METHODS
  Prospective case-series.
  
  
  METHODS
  Multicenter study in 11 trauma units.
  
  
  METHODS
  One-hundred and fifty-one patients were treated for the same number of proximal humerus fractures.
  
  
  METHODS
  Open reduction and internal fixation with the intramedullary PHN.
  
  
  METHODS
  Occurrence of postoperative complications during and up to 1 year of follow-up. The patients were actively followed up for 1 year with radiological assessment to observe fracture healing, alignment, reduction, and necrosis and by functional outcome measurements, including Constant, Disabilities of the Arm, Shoulder and Hand (DASH), and Neer scores.
  
  
  RESULTS
  A total of 113 patients (77% of 147 surviving patients) were available for the 1-year follow-up assessment, among whom 99% of all examined fractures had healed at this last time point. The range of motion (ROM) of the injured shoulder satisfactorily improved between all of the follow-up periods and by 1 year, 84-92% (ratio of injured to healthy contralateral shoulder) capacity had been achieved for all movements. The Constant score had significantly increased at the 3- and 6-month follow-ups, and by the final 1-year examination, this score attained up to 89% of the contralateral side. The mean baseline DASH was 5.9, with 62% of the total patient population having a zero DASH score. DASH scores higher than the preinjury scores were only observed in patients > 90 years of age, with this score significantly increasing with a mean difference of five points at the 1-year follow-up. At this last examination time point, patients had also reached a "satisfactory" mean Neer score of 85. Intraoperative complications were few (i.e., only four cases were documented) and solely related to the surgical technique; these problems included perforation of the articular surface by the oblique bolt or incorrect positioning of an additional screw. Humeral head necrosis was not common, with only four cases observed. Implant/surgery complications occurred in 63% (30/48) of the patients and included 13 cases of "cut through" (secondary impaction of the humeral head), nine cases of perforation of the articular surface, and four cases of implant loosening. Only four deaths were reported, and all were considered to be purely related to the patient and not to their participation in this study.
  
  
  CONCLUSIONS
  Nailing of proximal humeral fractures with the PHN is possible, but indication is limited to mainly A- and B-type fractures. The results of this multicenter study with many participating surgeons show that the operative technique is demanding and that the majority of documented complications are related to a violation of published basic technical steps during the operative procedure.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Klinikum Worms, Academic Teaching Hospital of the University Mainz, Worms, Germany. jochen.blum@klinikum-worms.de.|Department of Trauma, Hand and Reconstructive Surgery, Klinikum Worms, Academic Teaching Hospital of the University Mainz, 67550, Worms, Germany. jochen.blum@klinikum-worms.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Blum
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Klinikum Worms, Academic Teaching Hospital of the University Mainz, Worms, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hansen
authors.affiliation: AO Clinical Investigation and Documentation, Dübendorf, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Müller
authors.affiliation: Center for Trauma and Orthopedic Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Pol M
authors.initials: PM
authors.lastname: Rommens
authors.affiliation: Unfallkrankenhaus Meidling, Vienna, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Matuschka
authors.affiliation: Ortopediae Traumatologia, Azienda Ospedaliera di Padova, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Olmeda
authors.affiliation: Johannesburg Hospital-University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Marek J
authors.initials: MJ
authors.lastname: Radziejowski
authors.affiliation: Vogtlandklinikum Plauen, Plauen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Merbold
authors.affiliation: University Hospital Leuven, Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nijs
authors.affiliation: Centro Traumatologico Ortopedico Firenze, Florence, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Angeloni
keywords: Intramedullary nailing of long bones; Shoulder and hand
references.citation: Orthopade. 1992 Apr;21(2):106-14
references.pmid: 1594230
references.citation: J Bone Joint Surg Br. 2000 Nov;82(8):1107-12
references.pmid: 11132267
references.citation: Injury. 1999 Sep;30(7):453-62
references.pmid: 10707211
references.citation: Z Unfallchir Versicherungsmed. 1993;86(1):27-39
references.pmid: 8357685
references.citation: Unfallchirurg. 2002 Jan;105(1):9-13
references.pmid: 11968566
references.citation: Eur J Trauma Emerg Surg. 2007 Apr;33(2):149-58
references.pmid: 26816145
references.citation: Clin Orthop Relat Res. 1987 Jan;(214):160-4
references.pmid: 3791738
references.citation: Arch Orthop Trauma Surg. 1989;108(5):285-7
references.pmid: 2789504
references.citation: J Bone Joint Surg Br. 1997 Mar;79(2):295-300
references.pmid: 9119860
references.citation: Clin Orthop Relat Res. 1975 Oct;(112):250-3
references.pmid: 1192641
references.citation: Swiss Surg. 1996;(2):51-6
references.pmid: 8681108
references.citation: J Bone Joint Surg Am. 1970 Sep;52(6):1077-89
references.pmid: 5455339
references.citation: Unfallchirurgie. 1987 Apr;13(2):64-71
references.pmid: 3603876
references.citation: Z Unfallchir Versicherungsmed. 1992;85(3):156-62
references.pmid: 1493077
references.citation: Unfallchirurg. 1999 Jun;102(6):422-8
references.pmid: 10420821
references.citation: Unfallchirurg. 1997 May;100(5):349-53
references.pmid: 9297242
references.citation: Am J Ind Med. 1996 Jun;29(6):602-8
references.pmid: 8773720
references.citation: J Bone Joint Surg Br. 1993 Jan;75(1):132-6
references.pmid: 8421010
references.citation: Acta Orthop Scand. 1987 Feb;58(1):75-7
references.pmid: 3577743
references.citation: J Bone Joint Surg Am. 2003;85-A Suppl 4:136-46
references.pmid: 14652406