Intramedullary nailing of the proximal humerus: evolution, technique, and results

Journal of Shoulder and Elbow Surgery
Matthew F DilisioEdward V Fehringer

Abstract

Proximal humerus fractures are the third most common fracture in the elderly. Although most fractures can be treated conservatively with acceptable outcomes, certain fracture patterns are at high risk for progression to humeral malunions, nonunions, stiffness, and post-traumatic arthrosis. The goal of antegrade humeral nailing of proximal humerus fractures is to provide stability to a reduced fracture that allows early motion to optimize patient outcomes. Certain technical pearls are pivotal in managing these difficult fractures with nails; these include rotator cuff management, respect of the soft tissues, anatomic tuberosity position, blood supply maintenance, knowledge of the deforming forces on the proximal humerus, fracture reduction, and rehabilitation strategies. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and have demonstrated promising outcomes. Humeral nail designs have undergone significant innovation during the past 40 years and now can provide stable fixation in the humeral shaft distally as well as improved stability in the head and tuberosity fragments, which were the common site of fixation failure with earlier generation implants. Compared with other fi...Continue Reading

References

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Jun 29, 2007·International Orthopaedics·Bernd FüchtmeierLukas Prantl
Feb 20, 2008·Journal of Shoulder and Elbow Surgery·Gordon EdelsonDaniela Militianu
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Dec 21, 2010·Journal of Shoulder and Elbow Surgery·Brian BadmanMark Mighell
Mar 23, 2011·Journal of Shoulder and Elbow Surgery·Betsy M NolanGregory P Nowinski
Apr 27, 2012·Journal of Orthopaedic Trauma·Annie E KnierimEdward V Fehringer
Sep 28, 2012·Operative Orthopädie und Traumatologie·M H HessmannM Blauth
Feb 7, 2013·Orthopedics·Matthew F DilisioEric T Miller
Aug 22, 2013·Zeitschrift für Orthopädie und Unfallchirurgie·F FreynikR Pflugmacher
Sep 6, 2013·The Journal of Bone and Joint Surgery. American Volume·Wendy E BruinsmaUNKNOWN Science of Variation Group

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Citations

Aug 10, 2017·International Journal of Molecular Sciences·René SchiffnerMartin Schmidt
Feb 6, 2018·Geriatric Orthopaedic Surgery & Rehabilitation·Adam Schumaier, Brian Grawe
Jun 13, 2019·Journal of Orthopaedic Trauma·Sam-Guk Park, Young-Jin Ko
Apr 4, 2020·Journal of Orthopaedic Trauma·Ryley K ZastrowPaul J Cagle
Aug 21, 2020·Journal of Orthopaedic Trauma·Ryley K ZastrowPaul J Cagle
Sep 28, 2017·Journal of Orthopaedic Surgery and Research·Christoph J LauxGeorg Osterhoff
Feb 13, 2019·Journal of Orthopaedic Surgery and Research·John Tristan CassidyDiarmoud Molony
Dec 16, 2020·Orthopaedics & Traumatology, Surgery & Research : OTSR·Maxime AntoniPhilippe Clavert
Dec 29, 2019·Orthopaedics & Traumatology, Surgery & Research : OTSR·Christophe MuccioliPascal Boileau
Mar 24, 2021·The Orthopedic Clinics of North America·Adeshina AdeyemoGary Updegrove

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