Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar

Abstract

ObjectiveRestoration of the medial support is especially important for the treatment of proximal humeral fractures. The objective of this study was to investigate the radiographic and clinical outcomes of intramedullary nail fixation with a special focus on the presence of calcar comminution.MethodsIn this retrospective study of patients with displaced proximal humeral fractures that were treated by intramedullary nail between January 2018 and July 2021, fracture morphology and the calcar integrity were noted on preoperative radiographs. Patients were divided into two groups according to calcar integrity. During follow‐up, radiological assessment and functional outcome, including the deltoid tuberosity index (DTI), neck shaft angle (NSA), visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, active and passive range of motion, were performed. A Student t‐test and univariate logistic regression analysis was used.ResultsA total of 83 patients (54 female, 29 male) had complete follow‐up (average, 12.8 months; range, 10 to 33 months) and functional assessment in our study. The average age was 58.6 years (range, 20 to 89 years). The mean loss of NSA was 4° (range, 0°–12°) and no significant difference was found between two groups (p = 0.27). DTI had an average of 1.50 ± 0.19 (range 1.13–2.04). Patients with intact calcar achieved greater range of forward elevation (129.06 ± 11.91 vs. 121.05 ± 11.97, p = 0.01), and higher SST scores (8.61 ± 1.85 vs. 7.37 ± 2.22, p = 0.02). Two groups showed similar outcomes in VAS, ASES score, and range of abduction. One patient demonstrated a proximal interlocking screw cutting through and osteonecrosis of the humeral head, who underwent a second surgery for screw removal. There were no cases of infection, malunion, nonunion, nerve injury, subacromial impingement, or rotator cuff tear during the study period.ConclusionIntramedullary nail can favorably be used to manage proximal humeral fractures with good early radiographic and functional outcomes, even for those with comminuted calcar.

Shoulder and Elbow Surgery Special Issue

“…This issue features 32 professional articles, including three review articles, 21 clinical articles, four research articles, two operative techniques, and two case reports, contributed by well-known orthopaedic experts from China, the United States, Korea, and Europe.The elbow section of this issue includes papers on arthroscopy, 1 open surgery in elbow stiffness, 2,3 fractures, 4 total elbow arthroplasty, 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, [7][8][9][10][11] rotator cuff pathologies and fixation techniques, treatment of the post-surgical or post-traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,[12][13][14][15][16][17][18][19][20][21] the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. [22][23][24][25][26][27][28][29][30][31] Overall, this special issue contains plenty of meaningful readings for surgeons specializing in shoulder and elbow surgery and for general orthopaedic and trauma specialists, as well as for orthopaedic residents and young surgeons worldwide.…”

“…The elbow section of this issue includes papers on arthroscopy , 1 open surgery in elbow stiffness 2 , 3 fractures , 4 total elbow arthroplasty , 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7 , 8 , 9 , 10 , 11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”