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Intramedullary Nail for Proximal Humerus Fractures: An Old Concept Revisited

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Simple and Complex Fractures of the Humerus

Abstract

Displaced, unstable 2-, 3-, and 4-part proximal humerus fractures with a vascularized and attached head fragment require reduction and internal fixation. However, optimal treatment remains controversial, with various available options, but no single technique demonstrated to be superior or without complications. In this regard, intramedullary (IM) nailing may provide a suitable alternative to pinning (too weak a construct) and locked plating (too stiff a construct and an extensive approach with fracture-fragment devascularization). Since no existing nail designs fit our expectations, we revisited the concept of proximal humerus IM nailing. The Aequalis IM nail (Tornier, USA) is a new stabilization device for proximal humeral fractures, designed specifically to optimize tuberosity-fragment fixation and provide stable support for the humeral head, improving proximal humerus reconstruction and fixation in osteopenic bone. It provides the benefits of both percutaneous pinning (minimal soft tissue dissection) and plating (adequate fixation strength), without the drawbacks and complications of either technique. The objectives of this paper are as follows: (1) to analyze the common complications and problems related to IM nailing of proximal humerus fractures; (2) to describe the concept, design, and rationale of the Aequalis IM nail; (3) to provide some tips on using this nail, based on fracture type (2-, 3-, or 4-part); and (4) to report the early results obtained with this new device.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Sports Traumatology, L’Archet 2 Hospital, 151 route de St Antoine de Ginestière, Nice, 06200, France

    Pascal Boileau MD & Thomas d’Ollonne

  2. Department of Orthopaedic Surgery and Sports Traumatology, University of Nice Sophia-Antipolis, Hôpital de L’Archet, 151, Route de St. Antoine de Ginestière, Nice, 06202, France

    Pascal Boileau MD, Thomas d’Ollonne, Philippe Clavert & Armodios M. Hatzidakis

  3. Service de Chirurgie Orthopédique, Centre de Chirurgie Orthopédique et de la Main, Avenue Baumann, Illkirch, 67400, France

    Philippe Clavert

  4. Department of Orthopedics, Western Orthopaedics, 1830 Franklin St, Denver, CO, 80218, USA

    Armodios M. Hatzidakis

Authors
  1. Pascal Boileau MD
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  2. Thomas d’Ollonne
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  3. Philippe Clavert
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  4. Armodios M. Hatzidakis
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Corresponding author

Correspondence to Pascal Boileau MD .

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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, CTO Hospital Turin, Turin, Italy

    Filippo Castoldi

  2. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Davide Blonna

  3. Department of Orthopaedics and Traumatology, Mauriziano-Umberto I Hospital, Turin, Italy

    Marco Assom

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Boileau, P., d’Ollonne, T., Clavert, P., Hatzidakis, A.M. (2015). Intramedullary Nail for Proximal Humerus Fractures: An Old Concept Revisited. In: Castoldi, F., Blonna, D., Assom, M. (eds) Simple and Complex Fractures of the Humerus. Springer, Milano. https://doi.org/10.1007/978-88-470-5307-6_8

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  • DOI: https://doi.org/10.1007/978-88-470-5307-6_8

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