J Korean Fract Soc.  2013 Jan;26(1):14-20. 10.12671/jkfs.2013.26.1.14.

Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis

• Hwang YS
• Kim KY
• Kim HC
• Ahn SH
• Lee DE

• KMID: 1431711
• DOI: http://doi.org/10.12671/jkfs.2013.26.1.14

Abstract

PURPOSE
To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail.
MATERIALS AND METHODS
Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score.
RESULTS
All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points.
CONCLUSION
The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.

Keyword

Proximal humerus; Shaft; Osteoporosis; Avascular necrosis; Nonunion; Polarus; Intramedullary nail

MeSH Terms

Aged
Congenital Abnormalities
Elbow
Humans
Humerus
Nails
Necrosis
Osteoporosis
Shoulder
Shoulder Fractures

Figure

• 

  Fig. 1 Closed segmentally comminuted humeral shaft fracture in a 67-year-old man. (A) Pre-operative radiographs demonstrating the fracture. (B) Post-operative radiographs after closed reduction and internal fixation with the Polarus intramedullary nail. (C) Fourteen weeks follow up radiographs demonstrating healing across the fracture site with 13.1° varus angulation at humeral midshaft. Good function was achieved in this patient.

• 

  Fig. 2 Closed proximal 1/3 humeral fracture with an associated radial nerve palsy in a 70-year-old man. (A) Pre-operative radiographs demonstrating the fracture. (B) Post-operative radiographs after closed reduction and internal fixation with the Polarus intramedullary nail, without radial exploration was done. (C) Obvious union with callus formation was found 15 weeks after the operation.

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