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Review Article
Intramedullary Nail on the Humeral Fracture
Jin-Young Park, M.D., Jung-Hwan Oh, M.D., Duk-Hwan Kho, M.D., Jae-Kyoung Jung, M.D.
Journal of the Korean Fracture Society 2008;21(3):244-254.
DOI: https://doi.org/10.12671/jkfs.2008.21.3.244
Published online: July 31, 2008

Department of Orthopaedic Surgery, Konkuk Medical School, Seoul, Korea.

Address reprint requests to: Jin-Young Park, M.D. Department of Orthopaedic Surgery, Konkuk Medical School, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-914, Korea. Tel: 82-2-2030-7614, Fax: 82-2-2030-7369, drpark@chol.com

Copyright © 2008 The Korean Fracture Society. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 1. Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology, 1996;7:612-618.
  • 2. Bhandari M, Matthys G, McKee MD. Evidence-Based Orthopaedic Trauma Working Group. Four part fractures of the proximal humerus. J Orthop Trauma, 2004;18:126-127.
  • 3. Bigliani LU, D'Alessandro DF, Duralde XA, McIlveen SJ. Anterior acromioplasty for subacromial impingement in patients younger than 40 years of age. Clin Orthop Relat Res, 1989;246:111-116.
  • 4. Blum J, Janzing H, Gahr R, Langendorff HS, Rommens PM. Clinical performance of a new medullary humeral nail: antegrade versus retrograde insertion. J Orthop Trauma, 2001;15:342-349.
  • 5. Blum J, Machemer H, Baumgart F, Schlegel U, Wahl D, Rommens PM. Biomechanical comparison of bending and torsional properties in retrograde intramedullary nailing of humeral shaft fractures. J Orthop Trauma, 1999;13:344-350.
  • 6. Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br, 1997;79:857-865.
  • 7. Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clinc Orthop Relat Res, 1996;(324):292-320.
  • 8. Brumback RJ, Bosse MJ, Poka A, Burgess AR. Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg Am, 1986;8:960-970.
  • 9. Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007;31:391-395.
  • 10. Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma, 2000;14:162-166.
  • 11. Codman EA. Rupture of the supraspinatus tendon 1911. Clin Orthop Relat Res, 1990;254:3-26.
  • 12. Cofield RH. Comminuted fractures of the proximal humerus. Clin Orthop Relat Res, 1988;230:49-57.
  • 13. Cox MA, Dolan M, Synnott K, McElwain JP. Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail. J Orthop Trauma, 2000;14:349-353.
  • 14. Crates J, Whittle AP. Antegrade interlocking nailing of acute humeral shaft fractures. Clin Orthop Relat Res, 1998;350:40-50.
  • 15. Cuny C, Scarlat M, Irrazi M, et al. The telegraph nail for proximal humeral fractures: a prospective four-year study. J Shoulder Elbow Surg, 2008;17:539-545.
  • 16. Dabezies EJ, Banta CJ 2nd, Murphy CP, et al. Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries. J Orthop Trauma, 1992;6:10-13.
  • 17. Dimakopoulos P, Papadopoulos AX, Papas M, Panagopoulos A, Lambiris E. Modified extra rotator-cuff entry point in antegrade humeral nailing. Arch Orthop Trauma Surg, 2005;125:27-32.
  • 18. Esser RD. Treatment of three- and four-part fractures of the proximal humerus with a modified cloverleaf plate. J Orthop Trauma, 1994;8:15-22.
  • 19. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res, 2005;430:176-181.
  • 20. Füchtmeier B, May R, Hente R, et al. Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants. Arch Orthop Trauma Surg, 2007;127:441-447.
  • 21. Habernek H. A locking nail for fractures of the humerus. J Bone Joint Surg Br, 1998;80:557.
  • 22. Hawkins RJ, Angelo RL. Displaced proximal humeral fractures. Selecting treatment, avoiding pitfalls. Orthop Clin North Am, 1987;18:421-431.
  • 23. Hepp P, Lill H, Bail H, et al. Where should implants be anchored in the humeral head? Clin Orthop Relat Res, 2003;415:139-147.
  • 24. Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br, 2000;82:1107-1112.
  • 25. Hawkins RJ, Kiefer GN. Internal fixation techniques for proximal humeral fractures. Clin Orthop Relat Res, 1987;223:77-85.
  • 26. Ingman AM, Waters DA. Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results. J Bone Joint Surg Br, 1994;76:23-29.
  • 27. Instrum K, Fennell C, Shrive N, Damson E, Sonnabend D, Hollinshead R. Semitubular blade plate fixation in proximal humeral fractures: a biomechanical study in a cadaveric model. J Shoulder Elbow Surg, 1998;7:462-466.
  • 28. Jaberg H, Warner JJ, Jakob RP. Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Am, 1992;74:508-515.
  • 29. Koval KJ, Blair B, Takei R, Kummer FJ, Zuckerman JD. Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques. J Trauma, 1996;40:778-783.
  • 30. Kristiansen B, Christensen SW. Proximal humeral fractures. Late results in relation to classification and treatment. Acta Orthop Scand, 1987;58:124-127.
  • 31. Kristiansen B, Kofoed H. Transcutaneous reduction and external fixation of displaced fractures of the proximal humerus. A controlled clinical trial. J Bone Joint Surg Br, 1988;70:821-824.
  • 32. Lill H, Hepp P, Korner J, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg, 2003;123:74-81.
  • 33. Lin J, Hou SM. Antegrade locked nailing for humeral shaft fractures. Clin Orthop Relat Res, 1999;365:201-210.
  • 34. Lin J, Hou SM, Hang YS. Locked nailing for displaced surgical neck fractures of the humerus. J Trauma, 1998;45:1051-1057.
  • 35. Lin J, Hou SM, Hang YS, Chao EY. Treatment of humeral shaft fractures by retrograde locked nailing. Clin Orthop Relat Res, 1997;342:147-155.
  • 36. Lin J, Hou SM, Inoue N, Chao EY, Hang YS. Anatomic considerations of locked humeral nailing. Clin Orthop Relat Res, 1999;368:247-254.
  • 37. Lin J, Inoue N, Valdevit A, Hang YS, Hou SM, Chao EY. Biomechanical comparison of antegrade and retrograde nailing of humeral shaft fracture. Clin Orthop Relat Res, 1998;351:203-213.
  • 38. Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma, 1998;44:859-864.
  • 39. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am, 1970;52:1077-1089.
  • 40. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am, 1970;52:1090-1103.
  • 41. Park JY, An JW, Oh JH. Open intramedullary nailing with tension band and locking sutures for proximal humeral fracture: hot air balloon technique. J Shoulder Elbow Surg, 2006;15:594-601.
  • 42. Park JY, Pandher DS, Chun JY, Md ST. Antegrade humeral nailing through the rotator cuff interval: a new entry portal. J Orthop Trauma, 2008;22:419-425.
  • 43. Rajasekhar C, Ray PS, Bhamra MS. Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg, 2001;10:7-10.
  • 44. Riemer BL, D'Ambrosia R, Kellam JF, Butterfield SL, Burke CJ 3rd. The anterior acromial approach for antegrade intramedullary nailing of the humeral diaphysis. Orthopedics, 1993;16:1219-1223.
  • 45. Rommens PM, Verbruggen J, Broos PL. Retrograde locked nailing of humeral shaft fractures. A review of 39 patients. J Bone Joint Surg Br, 1995;77:84-89.
  • 46. Ruch DS, Glisson RR, Marr AW, Russell GB, Nunley JA. Fixation of three-part proximal humeral fractures: a biomechanical evaluation. J Orthop Trauma, 2000;14:36-40.
  • 47. Siegel JA, Dines DM. Proximal humerus malunions. Orthop Clin North Am, 2000;31:35-50.
  • 48. Tanner MW, Cofield RH. prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res, 1983;179:116-128.
  • 49. Verbruggen JP, Stapert JW. Humeral fractures in the elderly: treatment with a reamed intramedullary locking nail. Injury, 2007;38:945-953.
  • 50. Wachtl SW, Marti CB, Hoogewoud HM, Jakob RP, Gautier E. Treatment of proximal humerus fracture using multiple intramedullary flexible nails. Arch Orthop Trauma Surg, 2000;120:171-175.
  • 51. Weigand H, Müller HA, Gutjahr G, Ritter G. Classification of fractures of the proximal end of the humerus following prognostic and therapeutic aspects. Unfallchirurgie, 1984;10:221-236.
  • 52. Weise K, Grosse B, Hoffmann J, Sauer N. Results of treatment of 475 second- and third- degree open fractures long tubular bones (1974-1988). Aktuelle Traumatol, 1993;23:Suppl 1. 2-20.
  • 53. Wesely MS, Barenfield PA, Eisenstein AL. Rush pin intramedullary fixation for fractures of proximal humeus. J Trauma, 1977;17:29-33.
  • 54. Young TB, Wallace WA. Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg Br, 1985;67:373-377.
Fig. 1

(A) A 21-year-old woman with segmental fracture at the proximal shaft of the left humerus, which extends to surgical neck.

(B) The immediate post-nailing radiograph.
(C) The fractures unit anatomical position 1 year after operation.
jkfs-21-244-g001.jpg
Fig. 2

(A, B) Locking sutures and tension band sutures to increase the stability the humerus using #5 non-absorbable braided sutures.

jkfs-21-244-g002.jpg
Fig. 3

(A) A 62-year-old woman with comminuted 3-part fracture of the right proximal humerus.

(B) The 3D CT show severe comminution and osteoporosis.
(C-E) The fractures well unit 7 months after operation. The AVN of humeral head is not visible.
jkfs-21-244-g003.jpg
Fig. 4

(A, B) Distal cracking after reamed antegrade humeral nailing.

jkfs-21-244-g004.jpg
Fig. 5

(A, B) Further iatrogenic fracture after retrograde humeral nailing.

jkfs-21-244-g005.jpg
Fig. 6

Traction sutures on the rotator cuff attached to the greater and lesser tuberosity.

jkfs-21-244-g006.jpg
Fig. 7

Cement augmentation for rigid interlocking screw fixation during antegrade humeral nailing with osteoporotic patient.

jkfs-21-244-g007.jpg
Fig. 8

Insertion site of the retrograde intramedullary nail that is situated at the just above the olecranon fossa.

jkfs-21-244-g008.jpg
Fig. 9

New entry portal: Insertion site of the intramedullary nail on the humeral head that is situated at the medial side of the insertion of the supraspinatus and at the posterior side of the long head of biceps brachii.

jkfs-21-244-g009.jpg
Fig. 10

Exposure of the humeral head through rotator cuff interval (between the supraspinatus and subscapularis) in the proximal humeral fracture. The Antegrade humeral nailing is done through rotator cuff interval.

jkfs-21-244-g010.jpg

Figure & Data

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    Intramedullary Nail on the Humeral Fracture
    Image Image Image Image Image Image Image Image Image Image
    Fig. 1 (A) A 21-year-old woman with segmental fracture at the proximal shaft of the left humerus, which extends to surgical neck. (B) The immediate post-nailing radiograph. (C) The fractures unit anatomical position 1 year after operation.
    Fig. 2 (A, B) Locking sutures and tension band sutures to increase the stability the humerus using #5 non-absorbable braided sutures.
    Fig. 3 (A) A 62-year-old woman with comminuted 3-part fracture of the right proximal humerus. (B) The 3D CT show severe comminution and osteoporosis. (C-E) The fractures well unit 7 months after operation. The AVN of humeral head is not visible.
    Fig. 4 (A, B) Distal cracking after reamed antegrade humeral nailing.
    Fig. 5 (A, B) Further iatrogenic fracture after retrograde humeral nailing.
    Fig. 6 Traction sutures on the rotator cuff attached to the greater and lesser tuberosity.
    Fig. 7 Cement augmentation for rigid interlocking screw fixation during antegrade humeral nailing with osteoporotic patient.
    Fig. 8 Insertion site of the retrograde intramedullary nail that is situated at the just above the olecranon fossa.
    Fig. 9 New entry portal: Insertion site of the intramedullary nail on the humeral head that is situated at the medial side of the insertion of the supraspinatus and at the posterior side of the long head of biceps brachii.
    Fig. 10 Exposure of the humeral head through rotator cuff interval (between the supraspinatus and subscapularis) in the proximal humeral fracture. The Antegrade humeral nailing is done through rotator cuff interval.
    Intramedullary Nail on the Humeral Fracture

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