Intramedullary Nailing of Combined/Extended Fractures of the Humeral Head and Shaft

Objectives: To evaluate the use of intramedullary nailing in the management of both "combined" and "extended" fractures of the humeral head and shaft. Design: Retrospective case series study. Setting: Level I trauma center. Patients and Intervention: Twenty-one consecutive patients who underwent intramedullary nail insertion for "extended" or "combined," closed, nonpathologic fractures of the humeral head and shaft between October 1999 and December 2006 were included in the study. Two patients were lost to follow up and one died before fracture healing. Main Outcome Measurements: Evaluation of outcomes was assessed with the use of the Constant score. Results: There were no neurovascular problems or infections. Eighteen fractures united from 4 to 7 months postoperatively. One case of avascular necrosis of the humeral head, one case of acromion impingement, and one case of unacceptable loss of reduction occurred. Shoulder range of motion was not regained fully in any case and mild shoulder discomfort remained in eight patients. The mean Constant score for all 18 patients was 74.4 (range, 20-95) for the affected side and 89.17 points for the uninjured side. The percentage created from the mean affected/unaffected side scores was 83.4%. Conclusions: Intramedullary nailing for proximal humeral fractures associated with shaft extension or segmental involvement appears to offer a reliable treatment option.