Winkelstabile Marknagelosteosynthese für proximale Humerusfrakturen : Konzept und Ergebnisse

Abstract

Proximal humerus fractures are a challenge in terms of surgical treatment, particularly in elderly patients with osteopenia and severe injuries. Intramedullary implants have recently become available which offer various interlocking options to treat even comminuted fractures, providing them with good primary stability. Soft tissue protection using a minimally invasive implantation technique allows early physiotherapy and good functional results. Between June 2003 and July 2004 we used the T2 PHN (Stryker, Germany) in 40 patients with three- and four-part fractures and were able to perform a 1-year follow-up examination in 34 patients. The average age was 65 years and the mean constant score after 1 year was 73.7% on the affected limb. The side-adjusted result was 85.8%. There were 14 patients with four-part fractures among the 34 patients. Five patients developed partial avascular necrosis without requiring further treatment. Secondary dislocation was seen in three cases (one head fragment, two tubercula). Implant removal was performed in nine cases due to overlaying proximal locking screws or protruding proximal end of the nail. In summary, proximal humeral nails offer a less invasive treatment of even complex proximal humeral fractures with high primary stability. Special implant-related and anatomic features need to be considered for optimal treatment outcome. © 2008 Springer Medizin Verlag.