Journal of Musculoskeletal Trauma

Original Articles

Two-part and Three-part Fractures of the Proximal Humerus Treated with the Polarus Interlocking Nail: A Comparison of Fracture Types: Kyu Cheol Noh, Yung Khee Chung, Kook Jin Chung, Sung Ku Hong; J Korean Fract Soc 2006;19(2):182-187. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.182

PURPOSE
To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types.
MATERIALS AND METHODS
There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (<50) results. Radiographic outcome measurements included fracture alignment (neck-shaft angle), loosening of screw, fixation and hardware failure, and malunion and nonunion.
RESULTS
Overall, the average ASES score was 80.2 (range 46.0 to 98.0). There were 15/22 (68.2%) excellent, 6/22 (27.3%) satisfactory, and 1/22 (4.5%) poor results. All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. When comparing patients with two-part fractures (n=11) with patients having three-part fractures (n=11), there were statistically significant differences with ASES outcome measures (p<0.05). But, there were no statistically significant differences in age-related analysis (p>0.05).
CONCLUSION
Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.

Citations

Citations to this article as recorded by

Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis
Youn-Soo Hwang, Kwang-Yeol Kim, Hyung-Chun Kim, Su-Han Ahn, Dong-Eun Lee
Journal of the Korean Fracture Society.2013; 26(1): 14. CrossRef
Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus
Chul-Hyun Cho, Gu-Hee Jung, Kyo-Wook Kim
Journal of the Korean Fracture Society.2011; 24(3): 237. CrossRef

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Treatment of Two-part, Displaced Surgical Neck Fracture of the Proximal Humerus with Modified Ender Nail and Tension Band Technique: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):395-401. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.395

Abstract PDF

Operative treatment of two-part, displaced surgical neck fractures of the proximal humerus is used when satisfactory closed reduction cannot be achieved or maintained. Recently, we modified the Ender nails by making an additional hole above the slot for wire incorporation. The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing and tension band technique. We reviewed the data of fourteen consecutive patients (10 women and 4 men) who had been treated with Ender nailing and tension band wiring between from Aug 1996 and Oct 1997 at Eulji Medical College Hospital. The average age of patients was 54 years (range, 38 to 79 years), and the average follow-up period was 18 months (range, 12 to 24 months). Bone union was observed at 6.3 weeks (range, 5.5 to 10 weeks), except one case of delayed union. There were no infections and nonunions. The average ranges of shoulder elevation and abduction were 140 degrees(100 degrees to 170 degrees) and 126 degrees(100 degrees to 160 degrees), respectively. The median value of the thumb to vertebral distance was L1, with a range of T6 to L5 for internal rotation, external rotation was 48 degrees (30 degrees to 70 degrees) . Radiography revealed one case of medial shift greater than 5mm, and 4 cases of lateral shift greater than 5mm of the humeral shaft. The average varus angulation of the humeral neck was 8.5o(0 degree to 34 degrees). Four patients (28.6%) were excellent (34 to 35), six patients (42.8%) were good (28 to 33), four patients (28.6%) were fair (21 to 27) in UCLA shoulder rating scale. In conclusion, Ender nailing and incorporation of the tension band wire loops provided additionally rotational and longitudinal stability in two-part displaced surgical neck fracture of the proximal humerus associated with osteoporosis.

Citations

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Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis
Soo-Tai Chung, Joo-Hak Kim, Hyung-Soo Kim, Sang-Joon Park
Journal of the Korean Fracture Society.2007; 20(2): 184. CrossRef

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