Skip to main content
SpringerLink
Log in

Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures

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

Abstract

Introduction

The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial. Different treatment modalities are available. Mechanical implant-related problems, however, and the preservation of the biological integrity of the humeral head remain unsolved. New implants providing angular stability are expected to maintain the intraoperative result of reduction until definitive healing. The purpose of this study was to evaluate the functional outcome and the complication rate of an angular and sliding stable antegrade interlocking nail for the treatment of displaced proximal humeral fractures.

Materials and methods

In a prospective study, 112 consecutive patients with displaced proximal humeral fractures were treated. Complete 12 months postoperative follow-up was available for 74 patients. Fracture types were classified according to the Neer-classification. Clinical, functional and radiographic follow-up evaluations were performed 3, 6 and 12 months after surgery. The Constant Score (CS) was used to assess shoulder function.

Results

All fractures were united. The CS (MV ± SD) of the injured side 3, 6 and 12 months after surgery were 42.1 ± 15.1, 56.1 ± 20.1 and 70.9 ± 19.3, respectively. Patients sustaining Neer III and VI/3 fractures revealed better shoulder function (68.8 ± 14.7, 74.9 ± 17.6) 12 months postoperatively than those with Neer IV/4 fractures (60.7 ± 23.2), where most complications occurred. Complications requiring surgical therapy were seen in a total of 24 patients (30%) and included backing out of screws in nails without peak inlay (20%; 2000–2003), protrusion of screws into the gleno-humeral joint (5%), loss of reduction with malunion (9%) and major tubercle displacement (7%).

Conclusion

The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail (Targon-PH) led to good functional results, especially in 2- and 3-part fractures. There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures. Lateral backing out of screws was abolished by implant modifications (PEEK-inlay) from 2003 onwards. Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bjorkenheim JM, Pajarinen J, Savolainen V (2004) Internal Fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand 75:741–745

    Article  PubMed  Google Scholar 

  2. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  3. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R (2005) A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res 430:176–181

    Article  PubMed  Google Scholar 

  4. Gardner MJ, Griffith MH, Dines JS, Lorich D (2004) A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Jt Dis 62:18–23

    PubMed  Google Scholar 

  5. Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg 7:586–590

    Article  PubMed  CAS  Google Scholar 

  6. Gerber C, Werner CM, Vienne P (2004) Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 86:848–855

    Article  PubMed  CAS  Google Scholar 

  7. Gierer P, Simon C, Gradl G, Ewert A, Vasarhelyi A, Beck M, Mittlmeier T (2006) Complex proximal humerus fractures-management with a humeral head prosthesis? Orthopade 35:834–840

    Article  PubMed  CAS  Google Scholar 

  8. Habermeyer P (1997) Fracture of the head of the humerus. Unfallchirurg 1000:820–837

    Article  Google Scholar 

  9. Hessmann MH, Sternstein W, Blum J, Krummenauer F, Rommens PM (2003) Osteosynthesis of proximal humeral fractures with angular-stable plate fixation. Aktuelle Traumatol 33:2–6

    Article  Google Scholar 

  10. Hintermann B, Trouillier HH, Schäfer D (2000) Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br 82:1107–1112

    Article  PubMed  CAS  Google Scholar 

  11. Kollig E, Kutscha-Lissberg F, Roetman B, Mielke E, Muhr G, Hahn MP (2003) Primary hemiarthroplasty after complex fracture of the humeral head-functional late results. Zentralbl Chir 128:125–130

    Article  PubMed  CAS  Google Scholar 

  12. Lill H, Bewer A, Korner J, Verheyden P, Hepp P, Krautheim I, Josten C (2001) Conservative treatment of dislocated proximal humeral fractures. Zentralbl Chir 126:205–210

    Article  PubMed  CAS  Google Scholar 

  13. Lill H, Hepp P, Rose T, Konig T, Josten (2004) The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach-technique and first results. Zentralbl Chir 129:43–48

    Article  PubMed  CAS  Google Scholar 

  14. Lill H, Josten C (2001) Conservative or operative treatment of humeral head fractures in the elderly? Chirurg 72:1224–1234

    Article  PubMed  CAS  Google Scholar 

  15. Mathews J, Lobenhoffer P (2004) Results of the provision of unstable proximal humeral fractures in geriatric patients with a new angle stabilizing antegrade nail system. Unfallchirurg 107:372–380

    Article  PubMed  CAS  Google Scholar 

  16. McLaurin TM (2004) Proximal humerus fractures in the elderly. Are we operating on too many? Bull Hosp Jt Dis 62:24–32

    PubMed  Google Scholar 

  17. Mittlmeier TW, 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 85A:136–146

    Google Scholar 

  18. Neer CS (1970) Displaced proximal humeral fractures. II. Treatment of three part and four part displacement. J Bone Joint Surg Am 52:1090–1103

    PubMed  Google Scholar 

  19. Resch H (2003) Fractures of the humeral head. Unfallchirurg 106:602–617

    Article  PubMed  CAS  Google Scholar 

  20. Resch H, Povacz P, Fröhlich R, Wambacher M (1997) Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79:295–300

    Article  PubMed  CAS  Google Scholar 

  21. Sonderegger J, Simmen HP (2003) Epidemiology treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area. Zentralbl Chir 128:119–124

    Article  PubMed  CAS  Google Scholar 

  22. Stedtfeld HW, Attmanspacher W, Thaler K, Frosch B (2003) Fixation of humeral head fractures with antegrade intramedullary nailing. Zentralbl Chir 128:6–11

    Article  PubMed  Google Scholar 

  23. Tamai K, Ohno W, Takemura M, Mashitori H, Hamada J, Saotome K (2005) Treatmant of proximal humeral fractures with a intramedullary nail. J Orthop Sci 10:180–186

    Article  PubMed  Google Scholar 

  24. Tingart M, Bäthis H, Bouillon B, Tilling T (2001) The displaced proximal humeral fracture: is there evidence for therapeutic concepts? Chirurg 72(11):1284–1291

    Article  PubMed  CAS  Google Scholar 

  25. Wijgman AJ, Roolker W, Patt T, Raaymakers E, Marti R (2002) Open reduction internal fixation of three and four part fractures of the proximal part of the humerus. J Bone Joint Surg Am 84:1919–1925

    PubMed  Google Scholar 

  26. Zyto K, Ahrengart L, Sperber A, Tornkvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 79:412–417

    Article  PubMed  CAS  Google Scholar 

  27. Zyto K, Kronberg M, Brostrom LA (1995) Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg 4:331–336

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany

    Georg Gradl, Albrecht Dietze, Dagmar Arndt, Markus Beck, Philip Gierer, Tillmann Börsch & Thomas Mittlmeier

Authors
  1. Georg Gradl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Albrecht Dietze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dagmar Arndt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip Gierer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tillmann Börsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas Mittlmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg Gradl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gradl, G., Dietze, A., Arndt, D. et al. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 127, 937–944 (2007). https://doi.org/10.1007/s00402-007-0425-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-007-0425-5

Keywords

Search

Navigation