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Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients.

Methods

A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12 months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS.

Results

Mean age was 82.1 (range 80–90) and mean follow-up was 45.6 months (range 16–53 months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck–shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively.

Conclusion

Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population.

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Author notes

  1. Yaiza Lopiz and Daniel Garríguez-Pérez have contributed equally to this work.

Authors and Affiliations

  1. Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain

    Yaiza Lopiz, Daniel Garríguez-Pérez, Marina Martínez-Illán, Carlos García-Fernández & Fernando Marco

  2. Department of Surgery, Complutense University, Madrid, Spain

    Yaiza Lopiz & Fernando Marco

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  1. Yaiza Lopiz
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Correspondence to Yaiza Lopiz.

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No financial biases exist for any author or their family. Institutional Review Board (IRB) “Ethics Committee for Clinical Research” (CEIC) from Clínico San Carlos Hospital (Madrid, Spain) approve the present study Code: C.I. 19/475-E_TFG.

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Lopiz, Y., Garríguez-Pérez, D., Martínez-Illán, M. et al. Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications. Arch Orthop Trauma Surg 142, 227–238 (2022). https://doi.org/10.1007/s00402-020-03678-y

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