Skip to main content
SpringerLink
Log in

Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients

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

Abstract

Objective

To report on the results of a minimally invasive technique for the fixation of displaced proximal humeral fractures with a locked intramedullary nail.

Patients and methods

All consecutive patients treated with a T2™ intramedullary nail between 2004 and 2007 were evaluated. Thirty-three patients were included [mean age 78, m:f ratio (1:4)]. Fracture characteristics were classified according to AO and Neer (eighteen 2-part, eleven 3-part, five 4-part fractures).

Results

Functional outcome (Constant Score) was excellent in nine, satisfactory in eight and poor in three patients. Subjective outcome was satisfactory to good for patients with 2-part and 3-part fractures but poor for 4-part fractures. Major complications comprised four fixation failures, two cases of impingement and one deep infection.

Conclusions

Minimally invasive fixation of displaced 2-part and 3-part humeral fractures in an elderly population shows satisfactory to excellent results in 80% of patients.

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

Reference

  1. 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

    Article  CAS  PubMed  Google Scholar 

  2. Bufquin T, Hersan A, Hubert L et al (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 89:516–520

    Article  CAS  PubMed  Google Scholar 

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

  4. Court-Brown GargA, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371

    CAS  PubMed  Google Scholar 

  5. Diercks RL (2003) Proximale humerus fracturen: prothese of osteosynthese? Ned Tijdschr Trauma 6:158–164

    Google Scholar 

  6. Edwards SL, Wilson NA, Zhang LQ et al (2006) Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques. J Bone Joint Surg Am 88:2258–2264

    Article  PubMed  Google Scholar 

  7. Frangen TM, Muller EJ, Dudda M et al (2007) Proximal humeral fractures in geriatric patients. Is the angle-stable plate osteosynthesis really a breakthrough? Acta Orthop Belg 73:571–579

    PubMed  Google Scholar 

  8. Gaebler C, McQueen MM, Court-Brown C (2003) Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand 74:580–585

    Article  PubMed  Google Scholar 

  9. Gardner MJ, Weil Y, Barker JU et al (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21(3):185–191

    Article  PubMed  Google Scholar 

  10. Gronhagen CM, Abbaszadegan H, Revay SA et al (2007) Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg 16:766–773

    Article  PubMed  Google Scholar 

  11. Handoll HHG, Gibson JNA, Madhok R (2003) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev CD000434

  12. Hente R, Kampshoff J, Kinner B et al (2004) Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate. Unfallchirurg 107:769–782

    Article  CAS  PubMed  Google Scholar 

  13. Hessler C, Schmucker U, Matthes G et al (2006) Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate. Unfallchirurg 109:864–867

    Article  Google Scholar 

  14. Hodgson SA, Mawson SJ, Saxton JM et al (2007) Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). J Shoulder Elbow Surg 16:143–145

    Article  CAS  PubMed  Google Scholar 

  15. Katolik LI, Romeo AA, Cole BJ et al (2005) Normalization of the Constant score. J Shoulder Elbow Surg 14:279–285

    Article  PubMed  Google Scholar 

  16. Koval KJ, Gallagher MA, Marsicano JG et al (1997) Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am 79:203–207

    CAS  PubMed  Google Scholar 

  17. L’Insalata JC, Warren RF, Cohen SB et al (1997) A self-administered questionnaire for assessment of symptoms and function of the shoulder. J Bone Joint Surg Am 79:738–748

    Article  PubMed  Google Scholar 

  18. Neer CS (2006) Displaced proximal humeral fractures: part I. Classification and evaluation, 1970. Clin Orthop Relat Res 442:77–82

    Article  PubMed  Google Scholar 

  19. Nho SJ, Brophy RH, Barker JU et al (2007) Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 89(Suppl 3):44–58

    Article  PubMed  Google Scholar 

  20. Pavlopoulos DA, Badras LS, Georgiou CS et al (2007) Hemiarthroplasty for three- and four- part displaced fractures of the proximal humerus in patients over 65 years of age. Acta Orthop Belg 73:306–314

    PubMed  Google Scholar 

  21. Plecko M, Kraus A (2005) Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 17:25–50

    Article  PubMed  Google Scholar 

  22. Popescu A et al (2009) Internal fixation of proximal humerus fractures using the T2-proximal humeral nail. Arch Orthop Trauma Surg 129(9):1239–1244

    Article  PubMed  Google Scholar 

  23. Rajasekhar C, Ray PS, Bhamra MS (2001) Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg 10:7–10

    Article  CAS  PubMed  Google Scholar 

  24. Rasmussen S, Hvass I, Dalsgaard J et al (1992) Displaced proximal humeral fractures: results of conservative treatment. Injury 23:41–43

    Article  CAS  PubMed  Google Scholar 

  25. Sosef N, Stobbe I, Hogervorst M et al (2007) The Polarus intramedullary nail for proximal humeral fractures: outcome in 28 patients followed for 1 year. Acta Orthop 78:436–441

    Article  PubMed  Google Scholar 

  26. Stedtfeld HW, Mittlmeier T (2007) Fixation of proximal humeral fractures with an intramedullary nail: tips and tricks. Eur J Trauma Emergency Surg 33:367–374

    Article  Google Scholar 

  27. Vallier HA (2007) Treatment of proximal humerus fractures. J Orthop Trauma 21:469–476

    Article  PubMed  Google Scholar 

  28. Wijgman AJ, Roolker W, Patt TW et al (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-A:1919–1925

    CAS  PubMed  Google Scholar 

  29. Young TB, Wallace WA (1985) Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg Br 67:373–377

    CAS  PubMed  Google Scholar 

  30. Zyto K (1998) Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury 29:349–352

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

There is no conflict of interest in this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands

    Nico Sosef, Roderick van Leerdam, Sven Meylaerts & Steven Rhemrev

  2. Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands

    Pieter Ott

  3. Zwaardstraat 35, 2584 TN, The Hague, The Netherlands

    Nico Sosef

Authors
  1. Nico Sosef
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roderick van Leerdam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pieter Ott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sven Meylaerts
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven Rhemrev
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nico Sosef.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sosef, N., van Leerdam, R., Ott, P. et al. Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients. Arch Orthop Trauma Surg 130, 605–611 (2010). https://doi.org/10.1007/s00402-009-1027-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-009-1027-1

Keywords

Search

Navigation