[Treatment of unstable fractures of the proximal end of the humerus using elastic curved intramedullary wires].

At the Accident Hospital Lorenz Böhler and the Accident Hospital Meidling in Vienna, 48 patients with proximal humeral fractures were treated by closed reduction, intramedullary fixation with elastic pins and immobilization for two weeks in a Velpeau type stockinette (Gilchrist) between February 1985 and February 1986. The pins have a diameter of 2 mm. At there lower end there is a 20 mm long elastic curve which is ment to anker the pin in the entry hole to the intramedullary cavity, preventing sliding out of the implant. At the upper end the last 20 mm of the wire are angulated for 15 degrees. AO-classification was used. 39 patients had surgical neck-fractures. There were 34 displaced fractures (AO-type A 2/2), six dislocation- and more segment fractures and three epiphyseal separations of the adductiontype. The functional results of 36 patients were evaluated according to Neer's table. 29 patients had more than 80 points, four patients had more than 70 points and three had poor results. Reason for poor results was in one case a fracture with dislocation of the greater tuberosity which should have been treated by open reduction and the age in a 82 year old patient, who had a poor functional result after twelve weeks of treatment despite good fracture healing. There were no problems with wound healing, infections, myositis ossificans or Sudeck disease. Closed reductions of unstable surgical neck fractures and intramedullary fixation causes least damage to the soft tissues of the shoulder, leading to early good functional results.