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The Role of Intramedullary Nailing for Proximal Humerus Fractures: What Works and What Does Not

  • Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The evaluation of proximal humerus fractures (PHFs) should be aimed to answer the following four questions: (1) does the fracture need surgery in each particular patient? (2) if surgery is recommended, is it better to proceed with internal fixation or shoulder arthroplasty, (3) if internal fixation is recommended, what is the ideal fixation device strategy, and (4) how can outcomes be optimized? This review article tries to answer these questions and provides some clarity regarding what works and what does not in PHFs treated with intramedullary nailing.

Recent Findings

According to published articles on the treatment of PHFs with intramedullary nails, it is difficult to draw conclusions about outcomes and complications due to great variation in age, type of fracture, and nail designs included in the studies. However, the literature seems to support the use of modern nail designs for PHFs, especially in fractures of the surgical neck as well as varus posteromedial and valgus fractures with no tuberosity involvement.

Summary

Although the results of IMN in PHF seem to be better in two-part fractures, in more complex fractures, the quality of the reduction achieved seems to influence functional outcomes. Tuberosity malreduction leads to poor clinical outcomes, high rate of complications, and an increased risk of avascular necrosis. Malreduction of the humeral head increases the risk of postoperative loss of reduction, especially for varus posteromedial impacted fractures. A medial nail entry point decreases the risk of postoperative varus malunion, preserves the rotator cuff tendon, and avoids iatrogenic fractures of the GT. To decrease the risk of postoperative stiffness, fracture fixation should be stable enough to allow early mobilization.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Hospital Fundación Jimenez Diaz, Avenida de los Reyes Catolicos 2, 28040, Madrid, Spain

    Natalia Martinez-Catalan

  2. Department of Orthopaedics and Sports Surgery, University Institute of Locomotion and Sports, 7 Av Durante, 06000, Nice, France

    Pascal Boileau

Authors
  1. Natalia Martinez-Catalan
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Correspondence to Natalia Martinez-Catalan.

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Conflict of Interest

Pascal Boileau: designer and consultant for Tornier/Wright; outside the present study, Smith & Nephew, Conmed. The other author declares that she has no competing interest.

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Martinez-Catalan, N., Boileau, P. The Role of Intramedullary Nailing for Proximal Humerus Fractures: What Works and What Does Not. Curr Rev Musculoskelet Med 16, 85–94 (2023). https://doi.org/10.1007/s12178-022-09816-w

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