Outcomes of intramedullary nailing for acute proximal humerus fractures: a systematic review

Abstract

BackgroundWhile proximal humerus fractures remain common within the elderly population, the optimal treatment method remains controversial. Intramedullary nailing has been advocated as an effective and less invasive surgical technique. The purpose of this study is to elucidate the demographics, outcomes, and complications of intramedullary nailing for acute, displaced proximal humerus fractures.Materials and methodsMultiple computerized literature databases were used to perform a systematic review of English-language literature. Studies that met our stated criteria were further assessed for the requisite data, and when possible, similar outcome data were combined to generate frequency-weighted means.ResultsFourteen studies with 448 patients met our inclusion criteria. The frequency-weighted mean age was 64.3 years, and mean follow-up was 22.6 months. Females accounted for 71 % of the included patients. Three-part fractures (51 %) were most commonly treated. The overall frequency-weighted mean Constant score was 72.8, and American Shoulder and Elbow Surgeons (ASES) score was 84.3. Frequency-weighted mean forward elevation, abduction, extension, and external rotation were 137.3°, 138.4°, 33.8°, and 43.1°, respectively. The Constant score for two- and three-part fractures was significantly higher than for four-part fractures (p = 0.007 and p = 0.0009, respectively). The reoperation rate for two-, three-, and four-part fractures was 13.6, 17.4, and 63.2 %, respectively.ConclusionsIntramedullary nailing of acute, displaced two- and three-part proximal humerus fractures yields satisfactory clinical outcomes, although reoperation and complication rates remain high. Use of this implant for four-part fractures cannot be recommended until further clinical studies with larger patient numbers are available.Level of evidenceLevel IV, Systematic review.

Failure and revision rates of proximal humeral fracture treatment with the use of a standardized treatment algorithm at a level-1 trauma center

“…Outcome scores were of secondary interest in this failure analysis and served as quality control to ensure that the outcomes lie within the range of results that have been published previously. The mean raw Constant Score for non-operative treatment, locked nailing and locked plating was within the boundaries of what has been published before [ 14 – 16 , 23 ]. According to previously published results, the functional outcomes of prosthetic replacement were severely lower than the outcomes of reconstructive procedures, probably accounting for the more complex fracture types [ 24 , 26 – 28 ].…”

“…In this study, the rate of mandatory reoperations (15.2%) was within the range of complication and re-operation rates found in recent systematic reviews [ 11 , 15 , 16 ]. The rate of compulsory revision surgeries after locked nailing (13.4%) was slightly lower than reported in the literature (15.8%) [ 23 ].…”

Alteración de mediciones radiográficas en osteosíntesis de húmero proximal con clavo centromedular

“…12 En cuanto a otras complicaciones, como la consolidación viciosa, aflojamiento y pérdida de la reducción, nuestros resultados se encuentran dentro de parámetros similares a la serie de Wong. 28 Nuestra tasa de reintervención quirúrgica fue similar a Mathews 21 (4.4%), con una menor frecuencia a la reportada por Gadea 3 (25.4%), Gracitelli 15 (18.8%) o Wong 28 (15.8%).…”

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

“…This probably is a reflection that the general orthopaedic community is in agreement with their conclusions. 44 Good outcomes have been reported for fracture fixation with intramedullary nails but elderly patients tend to have poorer functional results and increased complications. 45 Nail design may impact on outcomes as straight nails have been shown to have better outcomes in terms of range of motion than curved nails, and the more medial insertion addresses the lateral cortex comminution better.…”