Proximal humeral fractures can be difficult to treat, particularly multifragmenting fractures in osteopenic bone. A large number of treatment modalities have been developed over the years. Treatments range from conservative measures such as swathe, to percutaneous procedures using pins, wires and screws onwards to open procedures with plate fixation and even joint replacement.
Problems lie in the difficulty of obtaining fixation of one or several fragments and achieving rotator cuff stability to allow early motion. Reduction and fixation must be performed without disturbing the blood supply to the fracture fragments. Finally, the implants used should be not interfere with surrounding soft tissue or the acromion. Additionally, the risk of implant migration should be minimized.
Advantages of Humeral Nailing
• Less extensive soft tissue dissection maximizes periosteal blood supply while preserving vital surrounding structures.
• Improved construct stability even in the case of comminated fractures and osteopenic bone while still maintaining desired elasticity.
• Fracture solutions, such as plating, are believed by some to be too rigid.
• Efficient procedure, especially when using a percutaneous approach.