Adoption of Intramedullary Nail Fixation for Proximal Humerus Fractures: Assessment of Surgical Efficiency and Complications


Fixation of proximal humerus fractures (PHFs) with intramedullary (IM) nails potentially is a newer, less invasive technique. The purpose of this study was to report on the early adoption results of IM nail use for PHF. Retrospective chart reviews were performed on the first 60 patients treated with IM nails for acute PHFs by two shoulder surgeons. The first 15 patients treated by each surgeon were compared with the subsequent 15 patients. Surgical and fluoroscopic times, fracture type, union, and varus collapse were compared. The average operating time decreased (p = .002). Fluoroscopy time, radiographic alignment, union rate, complications, and reoperations were not influenced. Three- and four-part fractures had a higher complication rate than two-part fractures (53% vs. 20%). When considering implementing use of IM nails for treatment of PHFs, initial cases can have outcomes and complications similar to those performed with greater experience. IM nailing appears a good treatment option for two-part PHFs. (Journal of Surgical Orthopaedic Advances 28(2):121–126, 2019) Key words: dynamic fixation, humerus fracture, intramedullary nail, learning curve, shoulder, surgeon experience, trauma

Brent A. Ponce, MD; Johnathan F. Williams, MD; Shawna L. Watson, MD; Jorge L. Perez, MD; Parke W. Hudson, MD; Jonathan H. Scott, MD; Djuro Petkovic, MD; Christopher M. Jobe, MD; Patrick D. Rowan, MD; and Wesley P. Phipatanakul, MD