Influence of Fracture Reduction on the Functional Outcome after Intramedullary Nail Osteosynthesis in Proximal Humerus Fractures

Background: Optimal treatment of proximal humeral fractures (PHF) is still controversial. Therefore, we aim to investigate the influence of fracture reduction after intramedullary nailing of a PHF on the clinical outcome. Methods: Patients treated with intramedullary nail for PHF from 2013-2018, (minimum follow-up 12 months) were retrospectively included. Constant Score (CS), DASH and Simple Shoulder Test (SST) were collected. Postoperative radiographs were used to determine head-shaft-alignment (HSA), head-shaft-displacement (HSD), integrity of the medial hinge and the cranialization of the greater tuberosity (CGT). The results of fracture reduction were categorized as either anatomical, acceptable or as malreduction. Malreduction exists when at least one of the following parameters are present: HSA > 150/< 110 degrees, HSD >5 mm, CTM > 5 mm or lack of integrity of the medial hinge. Results: 42 patients (mean age 65.5 +/- 14.1 years, 15 male, 27 female) with a mean follow-up time of 43 months were included. The average CS was 60 +/- 30, DASH 49.8 +/- 24.3 and SST 62.9 +/- 26.9. There was an anatomic reduction in 9 (21.4%), acceptable in 7 (16.6%) and a malreduction in 26 (62%) patients. Comparing the combined anatomical and acceptable reduction group with the malreduction group, worse scores were observed in the malreduction group (CS 67.2 vs. 55.2, DASH 45.2 vs. 51.9, SST: 69.3 vs. 58.6) without statistical significance (CS: p = 0.095, DASH: p = 0.307, SST: p = 0.400). By means of multiple logistic regression analyses no statistically significant risk factors were identified for lower DASH, CS and SST scores. Conclusions: Anatomical fracture reduction using intramedullary nails has a positive effect on postoperative outcome for the 3 scores recorded, without reaching statistical significance.

Automated summary

This study aimed to investigate the influence of fracture reduction after intramedullary nailing of proximal humeral fractures on the clinical outcome. The results showed that anatomical reduction had a positive effect on postoperative scores, but the differences compared to the malreduction group were not statistically significant.