Early failure of intramedullary nailing for proximal humeral fractures

Management of fracture upper end humerus with proximal humerus internal locking system

“…Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, Polarus nails, blade plates. [3][4][5][6][7][8] 17 PHILOS (proximal humeral internal locking system) is a recently developed system of ORIF, featuring: anatomically contoured shape, non-parallel locking head screws, high rigidity, Locking and LCP combination holes. Thus, theoretically less chance of screw pullout/loosening, better purchase in the humeral head and less secondary loss of reduction.…”

Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation

“…In elderly patients with comminuted fractures, conventional plate osteosynthesis has been associated with hardware problems because of lack of sufficient purchase, and it has been suggested that minimally invasive stabilization techniques may not allow early rehabilitation because of poor stability. 1,3 Recently, a locking plateescrew construct, which acts as a fixedangle device, has been proposed as a stable and tissuesparing fixation method for proximal humeral fractures. A locking plate reportedly ensures stable fixation of the humeral head and its surrounding fragments, even in poorquality bones, thereby facilitating early rehabilitation.…”

Techniques for Using a Novel Intramedullary Cage Technology for Fixation of Proximal Humeral Fractures

“…When compared to locking plates, a prospective randomized trial showed no difference in clinical outcomes at 3 years for patients with 2-part fractures [22]. Complications increase when nails are used for fixation of 3-and 4-part fractures with re-intervention rates reported as high as 45% [23]. Specific complications reported for use of intramedullary nail include screw penetration, nail migration, malunion, and rotator cuff injury resulting in pain to the patients [24].…”