Internal fixation of fractures of the proximal humerus with the MultiLoc nail
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.H. Hessmann1 · S. Nijs2 · T. Mittlmeier3 · M. Kloub4 · M.J.M. Segers5 · V. Winkelbach1 · M. Blauth6 1 Department of Orthopedics and Trauma Surgery, Academic Teaching Hospital Fulda 2 Department of Trauma Surgery, University Hospitals Leuven-Gasthuisberg, Leuven 3 Department of Trauma and Reconstructive Surgery, University Rostock 4 Department of Traumatology, Hospital Ceské Budejovice, Ceské Budejovice
Redaktion
5 Department of Trauma Surgery, Sint Antonius Hospital, EM Nieuwegen
A. Imhoff, München
6 Department of Trauma Surgery, University Hospital Innsbruck
Zeichner
R. Henkel, Heidelberg
Introductory remarks Fractures of the proximal humerus represent 5% of all fractures and belong to the three most common injuries in the elderly population. Especially in the aged population, osteoporotic bone properties make stable fixation a challenge even for the experienced surgeon. As in fractures of the proximal femur, the humeral head fragment offers only at the level of the subchondral bone sufficiently stable mechanical bone properties for reliable implant purchase. Significant progress in stable fracture fixation has been achieved in recent years by the development of implants with angle-stable properties. Locked plating systems like the PHILOS plate and intramedullary nails with angle-stable characteristics offer a higher intrinsic implant stability [2, 7, 8, 9, 10, 12]. These systems, therefore, are better able to maintain stable fracture reduction during functional after-treatment. In clinical practice, nails with anglestable properties are most commonly used for the treatment of simple fracture types such as subcapital two- and threepart fractures (with the main fracture line running through the surgical neck) [2, 6]. Locked plating systems are more versatile, since they offer a higher number of proximal locking options. Locked
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Operative Orthopädie und Traumatologie 2012
Internal fixation of fractures of the proximal humerus with the MultiLoc nail
diverging screws are inserted through the plate into different regions of the humeral head. They provide a more stable (lateral) buttress. Thus, locked plates are often preferred for the management of complex three- and four-part fractures [6]. However, nails have intrinsic advantages in comparison with plates also at the level of the proximal humerus [13]. The implant is inserted into the medullary cavity within the biomechanical loading axis of the bone. Owing to its central position, the lever arm of the screws is lower than in plates that are inserted in an excentric lateral position. In addition to these biomechanical advantages, nails are biologically advantageous for the elegant management of humeral head fractures extending into the shaft or for segmental fractures of the humeral head and shaft. This procedure can be mostly done through small incisions without direct exposure of the fracture. As long as the nail is inserted in a correct manner, there is a lower incidence of implant-related subacromial mechanical conflict than with plates. Mor
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