Treatment of two-part fractures of the surgical neck of the humerus using a locked metaphyseal intramedullary nail proximally with angular stability

Viecili, Leandro; Turco, Donato Lo; Ramalho, João Henrique Arruda; Finelli, Carlos Augusto; Torini, Alexandre Penna

doi:10.1016/j.rboe.2015.01.001

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Original Articles • Rev. bras. ortop. 50 (1) • Jan-Feb 2015 • https://doi.org/10.1016/j.rboe.2015.01.001 copy

Treatment of two-part fractures of the surgical neck of the humerus using a locked metaphyseal intramedullary nail proximally with angular stability ^☆ ☆ Work developed in the Institute of Orthopedics and Traumatology, Carmino Caricchio Municipal Hospital, Sao Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

To evaluate the functional results from patients with surgical neck fractures treated with a locked metaphyseal intramedullary nail and angular stability.

METHODS:

Twenty-two patients between the ages of 21 and 69 years were evaluated prospectively between January 2010 and January 2011. Their time taken for consolidation, age, sex, complications and functional results were correlated using the modified protocol of the University of California at Los Angeles (UCLA).

RESULTS:

The mean time taken for consolidation was 9.26 weeks ± confidence interval (CI) of 0.40 weeks. One case (4.5%) did not become consolidated. There were no cases of infection. There was one case (4.5%) of adhesive capsulitis with good evolution through clinical treatment. Five patients (22.7%) presented occasional mild pain and one case (4.5%) reported medium-intensity pain associated with the subacromial impact of the implant. The mean score on the modified UCLA scale was 30.4 ± CI 1.6 points, obtained at the end of 12 weeks of evaluation: 18 cases (81.8%) with "excellent" and "good" scores, three cases (13.6%) with "fair" scores and one case (4.5%) with a "poor" score.

CONCLUSION:

In the group of patients evaluated, treatment of two-part surgical neck fractures by means of a locked metaphyseal intramedullary nail and angular stability demonstrated satisfactory functional results and a low complication rate, similar to what is seen in the literature.

Humeral fracture; Intramedullary fracture fixation; Surgical procedures

Group	UCLA	Age	Sex	TC (weeks)	Complications
Excellent	35	23	F	9
	34	21	M	9
	34	24	F	9	Adhesive capsulitis, locking of SE
	34	41	M	10	Possible proximal pain
	34	69	F	10

Good	33	25	M	10
	33	39	F	10
	33	47	M	9	Slightly delayed consolidation
	32	40	M	10	Possible proximal pain
	31	33	M	8
	31	49	F	8	Possible proximal pain
	31	40	F	8	Possible proximal pain
	31	60	F	8
	31	29	M	10
	30	62	M	10	Delayed consolidation
	29	21	M	8
	29	48	M	10
	28	58	F	9	Possible proximal pain

Reasonable	26	47	M	11	Slightly delayed consolidation
Reasonable	25	28	M	9	High-energy fracture

Poor	25	65	F	10
Poor	19	41	M	No	Nail tore the head

Description	Age	UCLA	TC
Mean	41.4	30.4	9.26
Median	40.5	31.0	9.0
Standard deviation	14.9	3.9	0.94
CV	36%	13%	10%
Q1	28.3	29.0	9.0
Q3	48.8	33.0	10.0
Min	21	19	7.5
Max	69	35	11
N	22	22	21
CI	6.2	1.6	0.40

UCLA band	n	%	p-value
Poor	1	4.5%	<0.001
Reasonable	3	13.6%	0.002
Good	13	59.1%	Ref.
Excellent	5	22.7%	0.014

Sex	Age		UCLA		TC
	Female	Male	Female	Male	Female	Male
Mean	47.4	37.2	31.3	29.7	8.9	9.5
Median	49.0	40.0	31.0	31.0	9.0	10.0
Standard deviation	17.0	12.3	3.2	4.3	1.0	0.9
Q1	39.0	28.0	31.0	29.0	8.0	9.0
Q3	60.0	47.0	34.0	33.0	10.0	10.0
N	9	13	9	13	9	12
CI	11.1	6.7	2.1	2.3	0.6	0.5
p-value	0.181		0.345		0.188

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mails: leandro.viecili@hotmail.com, leandro.viecili@me.com(L. Viecili).

I – Pain
1) Present all the time and intolerable; medication used regularly	1
2) Present all the time but tolerable; medication used from time to time	2
3) No pain or little pain when the arm is not moving, but occurs during light work; medication used regularly	4
4) Occurs only during heavy work or specific work; medication used from time to time	6
5) Mild pain occurring from time to time	8
6) No pain	10

II – Function
1) Incapable of using the arm	1
2) Only capable of performing light activities	2
3) Capable of performing light domestic work or the majority of day-to-day work	4
4) Capable of performing most domestic work, including shopping, driving, combing hair, getting dressed, getting undressed and closing a bra	6
5) Little difficulty presented; capable of making movements above shoulder level	8
6) Normal activities	10

Instructions for goniometry
The patient should be in a seated position with the limb at the side of the body, in the neutral position. The examiner should instruct the patient to raise his arm as far as possible without making compensations.
The goniometer will be positioned with the proximal arm on the midaxillary line of the thorax and the distal arm on the lateral midline of the humerus, and the axis was placed close to the acromion.

III – Active anterior flexion
1) 150° or more	5
2) 120–150°	4
3) 90–120°	3
4) 45–90°	2
5) 30–45°	1
6) Less than 30°	0

Instructions for the manual strength test
The patient should be in a seated position with the limb beside the body and the forearm pronated. The patient should then raise this arm to 90°. The examiner should instruct him to maintain this position against the resistance that will be applied to the distal portion of the humerus (above the elbow).

IV – Active anterior flexion strength (manual strength test)
1) Grade 5 (normal)	5
2) Grade 4 (good)	4
3) Grade 3 (fair)	3
4) Grade 2 (weak)	2
5) Grade 1 (muscle contraction)	1
6) Grade 0 (absence of contraction)	0

V – Patient's satisfaction
1) Satisfied and better	5
2) Dissatisfied and worse	0
UCLA classification	Scoring
Excellent	34–35
Good	28–33
Reasonable	21–27
Poor	0–20

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Treatment of two-part fractures of the surgical neck of the humerus using a locked metaphyseal intramedullary nail proximally with angular stability ☆ ☆ Work developed in the Institute of Orthopedics and Traumatology, Carmino Caricchio Municipal Hospital, Sao Paulo, SP, Brazil.

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Treatment of two-part fractures of the surgical neck of the humerus using a locked metaphyseal intramedullary nail proximally with angular stability ^☆ ☆ Work developed in the Institute of Orthopedics and Traumatology, Carmino Caricchio Municipal Hospital, Sao Paulo, SP, Brazil.