[Results of the provision of unstable proximal humeral fractures in geriatric patients with a new angle stabilizing antegrade nail system].

Treating unstable proximal humeral fractures in elderly patients with osteoporosis and limited compliance is still demanding for trauma surgeons. The failure rate of operative treatment is high. We studied the use of a new antegrade intramedullary humeral nail with special locking bolts for head fixation. The first 41 procedures in 39 patients with a mean age of 81 years (61-102) were analyzed. Half of the patients were mentally deranged. There were 16 two-part, 22 three-part, and 3 four-part fractures of the humeral head treated. After closed or partial open reduction, antegrade nailing was performed via a delta split and limited incision of the rotator cuff. Greater and lesser tuberosities were fixed with screws through threaded holes of the proximal nail leading to high stability. Early functional active treatment was performed avoiding maximal rotation. Follow-up was 13 months (7-21 months). Clinical examination was performed in 32 cases. Four patients were questioned by phone. Three patients died (mean age: 92 years) before follow-up. The mean Constant score was 57+/-12. The mean age-related and side-related Constant scores were 86+/-17% and 90+/-7%. All fractures healed. Activities of daily life were possible in every case. There was only one loss of reduction after a fall out of bed. After hemiarthroplasty the patient was excluded from the study. One shaft fissure occurred during distal interlocking and healed uneventfully. Because of stable fixation, rehabilitation without immobilization was possible and led to good functional results. In comparison to common implants, the new antegrade intramedullary nail allowed a stable osteosynthesis in unstable proximal humeral fractures in old and very old patients with limited compliance without the usual implant-related complications.