PROXIMAL HUMERAL FRACTURE: OUR EXPERIENCE WITH THE T2 ANTEGRADE NAIL.

Abstract

Proximal humerus fracture treatment remains controversial. If the conservative treatment is widely accepted for Neer I and Neer II fractures, the attitude is not very clear concerning Neer III and Neer IV fractures.

Several methods are proposed in the literature varying from suturing, pinning or plating the proximal humerus. Hemiarthroplasty are even considered.

In our study we present our results of an internal fixation procedure for 3 part or 4 part fractures of the upper part of the humerus.

Material and Methods: Antegrade nailing with self stabilizing screws, by T2 nail, is used in 13 patients treated between January 2004 and December 2005. Average age is 81 years old. The medial insertion technique is used because of the greater tuberosity fracture. Clinical and radiological data were available for the 13 patients with a mean follow up of 19 months. Functional outcome is assessed using the Visual Analog Scale (VAS) and the Constant Score.

Results: At last follow up, most of the patients are satisfied with their operation with a mean VAS of 2.46 and a mean Constant Score of 64.7. Mean antepulsion was 148° while mean abduction was 136°. No infection was reported. There are 4 cases of greater tuberosity necrosis without influence on the rotator cuff muscles. One case of head necrosis is signaled.

Discussion: Complex fractures of the proximal humerus remain a challenge for the orthopedic surgeons. To date, there is non agreement on the most appropriate osteosynthesis method and the results of shoulder arthroplasty or proximal plating remain controversial. The T2 nail appears to be a simple and reproducible method of achieving reduction, stability and early mobilization. It is an attractive alternative to shoulder prosthesis or proximal plating in trauma victims with complex displaced fractures.