“Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature”

Abstract

BackgroundThe purpose of this study is to evaluate the functional outcome, union and complication rates after surgical treatment of unstable or displaced proximal humeral fractures using the Polarus intramedullary nail, by reviewing our institutional experience and the relevant current literature.MethodsTwenty-seven patients were treated operatively for proximal humeral fracture using the Polarus nail. Fractures were classified according to Neer’s classification. A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the Constant Shoulder Score. A comparison among functional outcomes in patients >60 years in relation to the younger ones was performed. Moreover, a review of the literature was carried out to evaluate the overall union and complication rates.ResultsTwo patients lost to follow-up were excluded from the analysis. For the twenty-five patients (mean age: 61 years), the mean follow-up was 36 months. There were 7 complications (28%), including one fixation failure, four protruded screws, one superficial infection and one case of impingement. The union rate was 96% (mean time to union: 4.2 months). The mean Constant score was 74.5 (range: 48–89). Patients under the age of 60 had a better functional outcome compared to patients >60 years of age (p<0.05). From the literature review and from a total of 215 patients treated with a Polarus nail, the mean union rate was 95.8%, the overall reported complication rate, including both minor and major complications, ranged widely from 9.3% up to 70%.ConclusionsThe Polarus nail was found to be an effective implant for stabilisation of proximal humeral fractures. Functional outcome is for the vast majority of the cases excellent or good, but in elderly patients a lower Constant score can be expected.

Polarus Nail Fixation for Proximal Humeral Fractures

“…16 In another study of 16 patients with 2-part and 5 patients with 3-and 4-part fractures, the union rate was 96% and complication rate was 28%; the mean constant score was 74.5; patients aged <60 years achieved better functional outcome. 17 Our study results were comparable with those in other studies in terms of fracture union, complications, functional outcome, and patient satisfaction, 14-17 but we had higher rates of minor hardware problems and failure in 3-part fractures. One limitation of this study was its retrospective nature.…”

Clinical outcomes and prognostic factors depending on implant design in the treatment of proximal humeral fractures: A retrospective study

“…4,[25][26][27][28] The functional outcomes and clinical outcomes regarding bone union in our study are largely comparable to those described in previous reports. 25,29 As for complications, although our study compared the proportions of patients with screw back-out and postoperative displacement, there was no clear difference observed between our study and previous reports.…”

Treatment of Proximal Humeral Fracture Using Polarus Nail and Philos Plate

“…[5][6][7] The current trend can be largely identified as the use of proximal nails and compression plate fixation, which are both improvements to the preceding methods. 8,9,11,12) Therefore, the authors used representative techniques of each method, the Polarus nail and Philos plate, respectively. Following surgical treatment, the authors compared the radiological and functional outcomes so as to be able to determine the key factors in choosing the most effective surgery method.…”

“…2,4) Polarus nails and Philos plates were introduced to counteract these complications, and their strengths include their ability for a stable fixation, limited complications, as well as the possibility of starting early joint motion exercise. [5][6][7][8][9][10] Under the humerus fractures, comparing the radiographical and functional outcomes, as well as analyzing the factors affecting the selection of the type of surgery.…”