Skip to main content
SpringerLink
Log in

New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Fractures of the proximal humerus are common and the repair of displaced fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have developed a new intramedullary nail (pin lock nail) for the repair of surgical neck fractures of the proximal humerus in patients with osteoporotic bones. A retrospective review is presented of the cases of 19 elderly patients with two-part or three-part fractures of the proximal humerus treated using the pin lock nail.

Methods

We treated 19 elderly patients with a mean age of 70.5 years. There were 13 two-part surgical neck fractures, 3 two-part surgical neck fractures with non-displaced greater tuberosity fracture, and 3 three-part surgical neck fractures with greater tuberosity fracture. All fractures were treated using the pin lock nail. Clinical results were evaluated using the Japanese Orthopaedic Association score at the last follow-up examination. On radiographic evaluation, duration to bone union of the fracture, backing out of the pin and screw, penetration of the proximal pin, and varus angulations of the humeral neck were examined.

Results

Mean duration of follow-up was 14 months (range 6–54 months). All fractures had united at an average of 3.3 months after surgery. No backing out of the pin and screw or penetration of the proximal locking pin was seen at the time of last follow-up. Thirteen of the 16 patients had no or minimal varus angulations of the humeral neck (≤10°). The mean overall JOA score was 84.3 points (range 65.5–100).

Conclusions

Our data show that using the pin lock nail for the treatment of two-part and three-part humeral fractures is a reliable procedure, providing good results with careful postoperative management.

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

Similar content being viewed by others

References

  1. Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T. Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone 1999;24:265–270.

    Article  CAS  PubMed  Google Scholar 

  2. Bengner U, Johnell O, Redlund-Johnell I. Changes in the incidence of fracture of the upper end of the humerus during a 30-year period. A study of 2125 fractures. Clin Orthop 1988;231:179–182.

    PubMed  Google Scholar 

  3. Kristiansen B, Barfod G, Bredesen J, Erin-Madsen J, Grum B, Horsnaes MW, et al. Epidemiology of proximal humeral fractures. Acta Orthop Scand 1987;58:75–77.

    CAS  PubMed  Google Scholar 

  4. Neer CS II. Displaced proximal humeral fractures: part I. Classification and evaluation. J Bone Joint Surg Am 1970;52:1077–1089.

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. Hessmann M, Baumgaertel F, Gehling H, Klingelhoeffer I, Gotzen L. Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores. Injury 1999;30:453–462.

    Article  CAS  PubMed  Google Scholar 

  7. Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand 1986;57:320–323.

    Article  CAS  PubMed  Google Scholar 

  8. Moda SK, Chadha NS, Sangwan SS, Khurana DK, Dahiya AS, Siwach RC. Open reduction and fixation of proximal humeral fractures and fracture-dislocations. J Bone Joint Surg Br 1990;72:1050–1052.

    CAS  PubMed  Google Scholar 

  9. Robinson CM, Christie J. The two-part proximal humeral fracture: a review of operative treatment using two techniques. Injury 1993;24:123–125.

    Article  CAS  PubMed  Google Scholar 

  10. Cornell CN, Levine D, Pagnani MJ. Internal fixation of proximal humerus fractures using the screw-tension band technique. J Orthop Trauma 1994;8:23–27.

    Article  CAS  PubMed  Google Scholar 

  11. Agel J, Jones CB, Sanzone AG, Camuso M, Henley MB. Treatment of proximal humeral fractures with Polarus nail fixation. J Shoulder Elbow Surg 2004;13:191–195.

    Article  PubMed  Google Scholar 

  12. Akiyama M. Biomechanical studies of bone mineral density of the humeral head and operative management of the proximal humeral fractures using retrograde intramedullary nails (in Japanese). Cent Jpn J Orthop Traumat 1998;41:1–6.

    Google Scholar 

  13. Lin J, Hou SM, Hang YS. Locked nailing for displaced surgical neck fractures of the humerus. J Trauma 1998;45:1051–1057.

    Article  CAS  PubMed  Google Scholar 

  14. Ogiwara N, Aoki M, Okamura K, Fukushima S. Ender nailing for unstable surgical neck fractures of the humerus in elderly patients. Clin Orthop 1996;330:173–180.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  16. Wachtl SW, Marti CB, Hoogewoud HM, Jakob RP, Gautier E. Treatment of proximal humerus fracture using multiple intramedullary flexible nails. Arch Orthop Trauma Surg 2000;120:171–175.

    Article  CAS  PubMed  Google Scholar 

  17. Kristiansen B, Kofoed H. Transcutaneous reduction and external fixation of displaced fractures of the proximal humerus. A controlled clinical trial. J Bone Joint Surg Br 1988;70:821–824.

    CAS  PubMed  Google Scholar 

  18. Sadowski C, Riand N, Stern R, Hoffmeyer P. Fixation of fractures of the proximal humerus with the PlantTan Humerus Fixator Plate: early experience with a new implant. J Shoulder Elbow Surg 2003;12:148–151.

    Article  PubMed  Google Scholar 

  19. Ko JY, Yamamoto R. Surgical treatment of complex fracture of the proximal humerus. Clin Orthop 1996;327:225–237.

    Article  PubMed  Google Scholar 

  20. Liew AS, Johnson JA, Patterson SD, King GJ, Chess DG. Effect of screw placement on fixation in the humeral head. J Shoulder Elbow Surg 2000;9:423–426.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Showa University Fujigaoka Rehabilitation Hospital, 2-1-1 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8518, Japan

    Kenichi Mihara, Hiroaki Tsutsui, Kazuhide Suzuki, Daisuke Makiuchi, Naoya Nishinaka & Ken Yamaguchi

Authors
  1. Kenichi Mihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroaki Tsutsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuhide Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Makiuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naoya Nishinaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ken Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Mihara, K., Tsutsui, H., Suzuki, K. et al. New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients. J Orthop Sci 13, 56–61 (2008). https://doi.org/10.1007/s00776-007-1193-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-007-1193-3

Keywords

Search

Navigation