title: Surgical treatment of complex proximal humeral fractures with a technique of nail and osteosuture: "NOS".
abstract: Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. The main objective of this procedure is to anatomically reduce the tuberosities. We propose a standardized and reproducible technique that we apply to all complex displaced 3- and 4-part fractures of patients under 50 years. We use an antero-lateral trans-deltoid approach; the humeral head and the tuberosities are reduced under fluoroscopic control. The tuberosities are stabilized with an inter-tuberosity osteosuture, and we then introduce a thin and straight intra-medullary nail (Telegraph IV FH Orthopedics) at the hinge point of the humeral head. The osteosynthesis of the tuberosities is completed by 3- or 4-self-stable divergent screws in the nail. A dynamic distal locking stabilizes the humeral shaft in rotation and facilitates consolidation thanks to micro movements. The removal of the nail with an arthroscopic shoulder arthrolysis in case of stiffness is possible secondarily.
authors.affiliation: Clinique du Parc, 155 Boulevard Stalingrad, 69006, Lyon, France. j.garret@cliniqueduparclyon.com.
authors.forename: J
authors.initials: J
authors.lastname: Garret
authors.affiliation: Orthopaedic and Trauma Department, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France.
authors.forename: H
authors.initials: H
authors.lastname: Houdré
authors.affiliation: Orthopaedic and Trauma Department, Lyon University Hospital Edouard-Herriot, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.
authors.forename: M
authors.initials: M
authors.lastname: Cievet-Bonfils
authors.affiliation: Centre Santy, 24 avenue Paul Santy, 69008, Lyon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Godenèche
authors.affiliation: Orthopaedic and Trauma Department, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Duparc
authors.affiliation: Orthopaedic and Trauma Department, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roussignol
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D000070799:Open Fracture Reduction / Q000379:methods; D018579:Patient Selection; D011182:Postoperative Care; D016059:Range of Motion, Articular; D012086:Reoperation; D012784:Shoulder Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Malunion of the tuberosities; Nail; Osteosuture; Proximal humeral fractures