Die winkelstabile Marknagelung bei Frakturen am proximalen Humerus mit dem PHN (Proximaler Humerusnagel)

ObjectiveStable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities.IndicationsUnstabile two- and three-part fractures of the proximal humerus (AO classification: 11-A2, 11-A3, 11-B1, 11-B2, 11-B3).Subcapital nonunion of the humerus.Pathologic fractures.ContraindicationsPediatric fractures of the proximal humerus.Fractures of the proximal humerus types 11-C2 und 11-C3 according to the AO classification.Active local infection, e.g., after former operation.Surgical TechniqueClosed reduction. Anterior acromial incision, splitting of the deltoid muscle and the rotator cuff. Opening of the medullary canal with the awl.Nail introduction. Spiral blade introduction in cannulated technique through stab incision.Distal interlocking through aiming device, angle-stable blocking of nail and blade through end cap.Postoperative ManagementPostoperative fixation in Gilchrist sling until 2nd postoperative day; then physiotherapy respecting fracture type and stability, local swelling, patient’s age and compliance, and concomitant injuries.Results151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.