Internal fixation of fractures of the proximal humerus with the MultiLoc nail

• Published in: Operative Orthopädie und Traumatologie Vol. 24; no. 4-5; pp. 418 - 431
• Main Authors: Hessmann, M.H., Nijs, S., Mittlmeier, T., Kloub, M., Segers, M.J.M., Winkelbach, V., Blauth, M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2012
• Subjects: Aged; Aged, 80 and over; Anatomy; Bone Nails; Female; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Fracture Healing - physiology; Hand Surgery; Humans; Intraoperative Complications - diagnostic imaging; Intraoperative Complications - etiology; Intraoperative Complications - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Techniken; Orthopedics; Plastic Surgery; Postoperative Care; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - surgery; Radiography; Reoperation; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - surgery; Surgical Equipment; Surgical Instruments; Surgical Orthopedics; Traumatic Surgery; Proximal; Nail; Nagel; Fracture; Humerus; Surgical technique; Chirurgische Technik; Fraktur
• ISSN: 0934-6694; 1439-0981
• DOI: 10.1007/s00064-011-0085-z

Objective Anatomical reduction of two- to four-part fractures of the proximal humerus using indirect reduction techniques. Intramedullary fixation with a short humerus nail. Restoration of a stable bone-implant construct that enables early functional after-treatment. Indications Displaced and unstable two- to four-part fractures of the proximal humerus. Fractures of the proximal humerus extending in the humeral diaphysis (use a long nail). Ipsilateral combined lesions of the proximal humerus and the humeral diaphysis (use a long nail). Contraindications Poor physical and/or mental status. Critical soft tissue conditions in the area near the surgical site. Local soft tissue infection. Pre-existing severe osteoarthritis of the shoulder joint; severe shoulder stiffness. Head-split fractures of the humerus head that cannot be reduced. Surgical technique Exposure of the fracture using an anterior acromial approach and determination of the correct nail entrance point. Anatomic fracture reduction using indirect reduction techniques. Stable fixation using an intramedullary MultiLoc® nail. Determination of the proximal locking configuration depending on the fracture morphology. Distal locking with angle-stable option. Post-operative treatment Post-operative radiographs for documentation of the surgical result and implant position. Use of an arm sling for 7–10 days. Active and passive exercises of the shoulder joint starting on day 1. Shoulder abduction limited to 60° for 2 weeks. Subsequent abduction to 90° until the 4th week. Subsequent active mobilisation without restrictions. Weight bearing and sporting activities after 3 months. Radiological evaluation after 2, 6 and 12 weeks. Results During a 6-month period, 160 patients were documented in a prospective clinical multicentre study. According to the AO classification, there were 36% A-type fractures, 41% B- and 23% C-type injuries. A 6-month follow-up was available for 17 patients. The mean age of these patients was 67 years. One patient had an A-type fracture. There were ten B- and six C-type fractures. At the time of follow-up, the mean Constant score was 66 points. Radiographically, all fractures had healed. Intra-articular screw penetration and loss of reduction were both observed once.