Stabilisation of proximal humeral fractures using antegrade angular and sliding stable interlocking screws (Targon PH)

An antegrade straight intramedullary nailing system with angular and sliding stable interlocking screws was employed for the treatment of dislocated 2-, 3- and 4-part proximal humeral fractures (standard nail) and of combined humeral head and shaft fractures (long nail version) even in the presence of manifest osteoporosis according to the principles of minimum invasive surgery. Isolated fractures of the tubercles and multiply fragmented humeral head fragments represented contraindications for the application of an intramedullary nail.The procedure allows active shoulder motion immediately postoperatively. Mid-term results of a prospective follow-up study of 50 patients with complete examinations after 3, 6 and 12 months postoperatively showed good functional results with 78.8 Constant score points after 1 year, corresponding to 92% of the Constant score of the contralateral intact side. However, numerous complications were observed, mainly related to the backing out of the fixation screws.The number of the severe complications which are mentioned in the literature, such as humeral head necrosis, pseudarthrosis, infection or redislocation, was limited. Correspondingly, patients with manifest complications had a less favourable functional result (65.8 Con- stant score points corresponding to 73% of the contralateral intact side). Present modifications of the surgical technique for stabilization of the tubercles (additional suture cerclage fixation of fragmented tubercles) and a novel technical modification preventing the backing out mechanism of the fixation screws are expected to decrease the complication rate.