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Short-term clinical and radiographic outcomes in patients treated with a modern intramedullary nailing system for 2-part proximal humerus fractures

  • James W. Connelly
    Correspondence
    Corresponding author.
    Affiliations
    Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, Riverside, Providence, RI, United States
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  • Jourdan H. Meltzer
    Affiliations
    Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, Riverside, Providence, RI, United States
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  • David C. Tapscott
    Affiliations
    Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, Riverside, Providence, RI, United States
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  • Janine Molino
    Affiliations
    Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, Riverside, Providence, RI, United States

    Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI, United States
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  • Andrew Green
    Affiliations
    Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, Riverside, Providence, RI, United States
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  • E. Scott Paxton
    Affiliations
    Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, Riverside, Providence, RI, United States
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Published:November 08, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.009

      Abstract

      Objectives

      The optimal surgical treatment of displaced proximal humerus fractures (PHFs) remains controversial. There are advocates for both open reduction and internal fixation with plate and screws (ORIF) and intramedullary nailing (IMN). The purpose this study was to evaluate the early-term clinical and radiographic outcomes of IMN for isolated, displaced 2-part surgical neck PHFs using a modern, straight nail system and to determine the effect of preoperative patient and fracture characteristics on outcome.

      Methods

      This was a case series of 23 patients with displaced 2-part surgical neck PHFs who were treated with ORIF using a straight IMN with minimum follow-up of 1 year (mean 2.5 years [range, 1.1–4.6]). Patients were identified retrospectively and contacted for measurement of active range of motion (AROM) and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS), and Single Assessment Numeric Evaluation (SANE), EuroQol-5D (EQ-5D), and Visual Analog Scale Pain score (VAS Pain). Plain radiographs were evaluated to assess the quality of the reduction and failure of fixation. Complications and reoperations were identified.

      Results

      Reduction was anatomic in 12 (52%) patients, acceptable in 9 (39%), and 2 (9%) were malreduced. There were no differences in reduction quality based on sex (p = 0.37), age at surgery (p = 0.68), calcar comminution (p = 0.68), number of screws in the head (p = 0.99), or medial hinge disruption (p = 0.06). At final follow-up, the mean ASES score was 92 ± 10, OSS was 45 ± 4, SANE was 93 ± 7, EQ-5D of 0.85 ± 0.17, and VAS Pain was 0 ± 1. The mean active forward flexion was 143° ± 16°, active external rotation was 68° ± 20°, and internal rotation was T11 ± 4 vertebrae. Two (9%) patients underwent reoperation and 2 (9%) patients experienced clinical failure not requiring reoperation.

      Conclusions

      Straight IMN is a reliable treatment for displaced 2–part surgical neck PHFs with excellent radiographic and clinical outcomes in early follow-up. The implant facilitated anatomic or acceptable alignment of the fracture in the vast majority of patients.

      Keywords

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