A New Approach to Operative Treatment of Proximal Humeral Fractures: Intramedullary Nailing with Fixed-Angle Locking Screws

Introduction Proximal humeral fractures represent 4 to 5 per cent of all fractures in adults [ 2 ] [ 9 ] and account for 75 per cent of all fractures of the humerus in patients over 40 years of age [ 10 ]. The ultimate goal in the treatment of proximal humeral fractures is free range of motion of the shoulder joint. Conservative methods are the therapy of choice for simple and non-displaced fractures [ 5 ]. For severely displaced fractures surgery is necessary to obtain anatomic reduction and rigid fixation. Several operative treatment options exist but complex fractures still Iead to unsatisfactory results in the majority of cases. Osteoporosis often poses problems with secure fixation of the implant of choice. The proximity of the brachial plexus and the vascular anatomy of the proximal humerus can cause problems due to the trauma itself or due to surgical interventions [ 3 ]. As an alternative to known treatment options a new implant in the form of an unreamed intramedullary nail with fixed-angle locking screws (TARGON-PH-nail, Fa. Aesculap, Tuttlingen) is presented which not only leads to stable fixation of the fracture but also allows for early postoperative mobilization of the shoulder joint in the majority of treated cases.