Nail Fixation of Proximal Humerus Fractures

Proximal humerus (PH) fractures are among the most fracture types. Surgery is indicated in displaced fractures. The charge-book for surgical management of PH fractures is restoring PH anatomy, obtaining stable osteosynthesis, and conserving PH vascularization. Proximal humerus nailing is an osteosynthesis technique we have been using since 2000. Our initial indication for using a nail for PH fractures was displaced fractures of the surgical neck in elderly patients; these have since been expanded to include 3-part fractures, some special proximal humeral fracture dislocations, and 4-part valgus impacted fractures. However, nail fixation for PH fracture is not a panacea, and our surgical arsenal also includes bone sutures, percutaneous osteosynthesis, anatomical PH plates, and PH fracture prostheses. We detail the technique and the indication for each case. This technique is technically demanding, but after a learning curve, nail fixation for PH fractures is a very good technique if the indication is well defined.