title: Long endomedullary nail in proximal third humeral shaft fractures.
abstract: BACKGROUND
  Proximal humeral fractures with a spiral line of fracture extending from the humeral head to the diaphyseal region are increasing. Treatment for these fractures is comparable to that for shaft fractures. The purpose of this study was to evaluate the use of a new "Long" humeral nail for this type of lesion and identify the best distal locking.
  
  
  METHODS
  Forty-three patients treated with a Long Diphos Nail®were selected for this study: main exclusion criteria were poor cognitive and responsive ability to physical therapy, four-part fracture requiring humeral head replacement, an isolated greater or lesser tubercle fracture and a head-splitting fracture. All patients were divided into two groups according to the distal locking (single or double) and clinically evaluated at 1, 3, 6 and 12 months after surgery. The following parameters were evaluated: fracture healing on radiographic images every month; level of pain with Visual Analogue Scale (VAS); recovery of shoulder function or ability to resume normal daily activities according to the Constant Scoring System (CSS); patient satisfaction; and complications, like fracture consolidation defect or delay. A statistical analysis was performed.
  
  
  RESULTS
  Improvements in pain, satisfaction and shoulder functional recovery were recorded. Patients reached fracture healing in two to six months. The mean healing time was better for double distal locking (p=0.04).There was a clinically greater difference (p=0.006) between the groups for the mean Constant score at 3 months follow-up, with better results for the double distal locking group. Complications were: one patient with a consolidation delay with a single distal locking screw breakage; it was necessary to remove the nail and perform a second treatment.
  
  
  CONCLUSIONS
  The results of the study indicate the efficacy of Long Diphos Nail®in the treatment of fractures with a line of fracture extending to the proximal diaphyseal region. The features of a multiplane stabilisation above the fracture and a distal double locking may represent the key for a good fixation for 11-A2, A3 or B2 fractures with a long spiral line. A double distal locking reduces fracture micro-instability and so patients recover function and strength quicker because of less pain at the fracture site.
  
  
  METHODS
  retrospective, cohort of cases.
  
  
  METHODS
  IV.
authors: Department of Orthopaedics and Traumatology, Piacenza Hospital, Italy. Electronic address: marco.caforio@tiscali.it.
authors: Marco
authors: M
authors: Caforio
authors: Department of Orthopaedics and Traumatology, Piacenza Hospital, Italy.
authors: Pietro
authors: P
authors: Maniscalco
authors: Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Italy.
authors: Massimiliano
authors: M
authors: Colombo
authors: Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Italy.
authors: Giorgio Maria
authors: GM
authors: Calori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Distal locking; Humeral shaft fractures; Long humeral nail; Proximal humeral fracture