Garret J, Houdré H, Cievet-Bonfils M, Godenèche Arnaud, Duparc Fabrice, Roussignol Xavier
Clinique du Parc, 155 Boulevard Stalingrad, 69006, Lyon, France.
Orthopaedic and Trauma Department, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France.
Eur J Orthop Surg Traumatol. 2017 Apr;27(3):391-397. doi: 10.1007/s00590-017-1939-3. Epub 2017 Mar 14.
Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. The main objective of this procedure is to anatomically reduce the tuberosities. We propose a standardized and reproducible technique that we apply to all complex displaced 3- and 4-part fractures of patients under 50 years. We use an antero-lateral trans-deltoid approach; the humeral head and the tuberosities are reduced under fluoroscopic control. The tuberosities are stabilized with an inter-tuberosity osteosuture, and we then introduce a thin and straight intra-medullary nail (Telegraph IV FH Orthopedics) at the hinge point of the humeral head. The osteosynthesis of the tuberosities is completed by 3- or 4-self-stable divergent screws in the nail. A dynamic distal locking stabilizes the humeral shaft in rotation and facilitates consolidation thanks to micro movements. The removal of the nail with an arthroscopic shoulder arthrolysis in case of stiffness is possible secondarily.
