Treatment of proximal humerus fracture using multiple intramedullary flexible nails

A total of 61 patients with a proximal humeral fracture was treated between January 1996 and March 1998 by-closed reduction and fracture fixation with intramedullary Prevot (or Nancy) nails. Of these, 28 female and 25 male pa tients with a mean age of 52 years (range 3-91 years) were reviewed clinica lly and radiologically with a mean follow-up of 17 months (range 4-30 month s). The mean Constant score was 63, the mean Neer score 74 and the mean:vis ual analogue scale (VA) 73. The 14 patients under 24 years old achieved a C onstant score of 86, a Neer score of 99 and a VAS of 97, while 13 patients aged between 25 and 60 years had a Constant score of 67, a Neer score-of 75 and a VAS of 71. The 26 patients older than 61 years had a Constant score of 48, a Neer score of 61 and a VAS of 61. One patient with total and 6 wit h partial humeral head necrosis as well as 5 pseudarthroses were noted. Pro ximal nail perforation of the humeral head due to-fracture collapse was see n in 22 cases. Complications were more frequently observed in the elderly. End results were not related to the type of fracture. This minimally invasi ve technique decreases the rate of occurrence of avascular necrosis of the humeral head. However, fractures are not sufficiently stabilised, mainly be cause of bone loss induced by impaction and osteoporosis. Bone loss remains an unsolved problem, and alternative methods such as the use of done subst itute combined with minimally invasive techniques should be studied.