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Title of Journal: Arch Orthop Trauma Surg

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Abbravation: Archives of Orthopaedic and Trauma Surgery

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Springer-Verlag

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DOI

10.1002/cpe.4056

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1434-3916

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Angular and sliding stable antegrade nailing Targ

Authors: Georg Gradl Albrecht Dietze Dagmar Arndt Markus Beck Philip Gierer Tillmann Börsch Thomas Mittlmeier
Publish Date: 2007/09/27
Volume: 127, Issue: 10, Pages: 937-944
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Abstract

The optimal surgical treatment for displaced proximal humeral fractures continues to be controversial Different treatment modalities are available Mechanical implantrelated problems however and the preservation of the biological integrity of the humeral head remain unsolved New implants providing angular stability are expected to maintain the intraoperative result of reduction until definitive healing The purpose of this study was to evaluate the functional outcome and the complication rate of an angular and sliding stable antegrade interlocking nail for the treatment of displaced proximal humeral fracturesIn a prospective study 112 consecutive patients with displaced proximal humeral fractures were treated Complete 12 months postoperative followup was available for 74 patients Fracture types were classified according to the Neerclassification Clinical functional and radiographic followup evaluations were performed 3 6 and 12 months after surgery The Constant Score CS was used to assess shoulder functionAll fractures were united The CS MV ± SD of the injured side 3 6 and 12 months after surgery were 421 ± 151 561 ± 201 and 709 ± 193 respectively Patients sustaining Neer III and VI/3 fractures revealed better shoulder function 688 ± 147 749 ± 176 12 months postoperatively than those with Neer IV/4 fractures 607 ± 232 where most complications occurred Complications requiring surgical therapy were seen in a total of 24 patients 30 and included backing out of screws in nails without peak inlay 20 2000–2003 protrusion of screws into the glenohumeral joint 5 loss of reduction with malunion 9 and major tubercle displacement 7The treatment of displaced proximal humeral fractures with an angular and sliding stable antegrade nail TargonPH led to good functional results especially in 2 and 3part fractures There exists a substantial risk for postoperative complications and bad motor function in Neer IV/4 fractures Lateral backing out of screws was abolished by implant modifications PEEKinlay from 2003 onwards Additional tension wire banding of the major tubercle may further reduce the risk of secondary displacement

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