Abstract
Introduction
A variety of different treatment options are available for displaced three- or four-part fractures. In a retrospective cohort study we evaluated the results of intramedullary nailing with the ACE nail and conservative treatment of displaced proximal humeral fractures.
Materials and methods
Twenty-four patients suffered a neer 4, 5 or 6 proximal humeral fracture who were treated with intramedullary nailing. Sixteen patients received conservative treatment for their Neer 4, 5 or 6 fracture.
Results
Taking critical remarks in consideration, the results of intramedullary nailing are not very satisfactory compared to the conservative-treated group. However functional results of our operative group are comparable to those from other studies in literature.
Conclusion
Displaced three- or four-part proximal humeral fractures can be treated by intramedullary nailing. Familiarity with the fracture deformity and experience with the surgical techniques are critical for successful operative treatment outcome. Most complications in the operative treatment group can be avoided; inadequate reduction can lead to wrong insertion place with secondary problems (dislocation and subacromial impingement). Also future improvements in osteosynthesis like angle stable screw fixation (osteoporosis) and minimally invasive device will probably decrease the complication rate.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lind T, Kroner K, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108:285–287
Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371
Neer CS II (1970) Displaced proximal humeral fractures. Part I. classification and evaluation. J Bone Joint Surg Am 52-A:1077–1089
Agel J, Jones CB, Sanzone AG, Camuso M, Bradford Henley M (2004) Treatment of proximal humeral fractures with Polarus nail fixation. J Shoulder Elbow Surg 13(2):191–195
Cofield RH (1988) Comminuted fractures of the proximal humerus. Clin Orthop 168:24–30
Zyto K, Ahrengart L, Sperber A, Törnqvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 79-B:412–418
Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–163
Mills HJ, Horne G (1985) Fractures of the proximal humerus in adults. J Trauma 25:801–805
Zyto K (1998) Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury 29:349–352
Neer CS (1970) Displaced proximal humerus fractures: part II: treatment of three-part and four-part displacement. J Bone Joint Surg Am 52-A:1090–1103
Rasmussen S, Hvass I, Dalsgaard J, Christensen BS, Holstad E (1992) Displaced proximal humeral fractures: results of conservative treatment. Injury 23(1):41–43
Gerber C, Werner CML, Vienne P (2004) Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 86-B:848–855
Adedapo AO, Ikpeme JO (2001) The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury 32:115–121
Rees J, Hicks J, Ribbans W (1998) Assessment and management of three and four-part proximal humeral fractures. Clin Orthop Relat Res 353:18–29
Hintermann B, Trouillier HH, Schäfer D (2000) Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br 82-B:1107–1112
Mittlmeier ThWF, Stedtfeld HW, Ewert A, Beck M, Frosch B, Gradl G (2003) Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH). J Bone Joint Surg Am 85-A:136–146
Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD (1995) Functional outcome after humeral head replacement for acute three and four part proximal humeral fractures. J Shoulder Elbow Surg 4(2):81–86
Moeckel BH, Dines DM, Warren RF, Altchek DW (1992) Modular hemiarthroplasty for fractures of the proximal part of the humerus. J Bone Joint Surg Am 74-A(6):884–889
Wretenberg P, Ekelund A (1997) Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed up for 2–7 years. Acta Orthop Scand 68(2):121–123
Zyto K, Wallace WA, Frostick SP, Preston BJ (1998) Outcome after hemiarthroplasty for three and four part fractures of the proximal humerus. J Shoulder Elbow Surg 7(2):85–89
Robinson CM, Page RS, Hill RMF, Sanders DL, Court-Brown CM, Wakefield AE (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 85-A(7):1215–1223
Hartsock LA, Estes WJ, Murray CA, Friedman RJ (1998) Shoulder hemiarthroplasty for proximal humeral fractures. Orthop Clin North Am 29(3):467–475
Misra A, Kapur R, Maffulli N (2001) Complex proximal humeral fractures in adults—a systematic review of management. Injury 32:363–372
Handoll HHG, Gibson JNA, Madhok R (2003) Interventions for treating proximal humeral fractures in adults. Cochrane Database of Syst Rev, Issue 4. Art. No. CD000434
Wijgman AJ, Roolker W, Patt TW (2002) Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am 84(11):1919–1925
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van den Broek, C.M., van den Besselaar, M., Coenen, J.M.F. et al. Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment. Arch Orthop Trauma Surg 127, 459–463 (2007). https://doi.org/10.1007/s00402-006-0250-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-006-0250-2