Is antegrade nailing a proper option in 2- and 3-part proximal humeral fractures?

  • S. CongiaEmail author
  • A. Palmas
  • G. Marongiu
  • A. Capone
Original Article



To report our experience with antegrade short locked intramedullary nail for treatment of proximal humeral fractures and to review the current literature.

Materials and methods

From January 2012 to July 2013, 41 patients affected by two and three-part proximal humeral fractures were treated with surgical internal fixation with short locked intramedullary nails. Outcome analysis included standard clinical follow-up, Constant shoulder score and plain radiographs. The mean follow-up was 30 months (range 24–42). Moreover, a review of the literature was carried out.


The mean Constant shoulder score was 81.5, excellent functional outcomes in 24/38 patients. All the fractures healed in an average time of 3.7 months. Five patients underwent additional operations, complications included hardware penetration into the joint (n = 2), backed out screw (n = 1), shoulder impingement due to protrusion of the nail (n = 2) and superficial infection (n = 1). The literature review showed 530 patients affected by proximal humeral fracture and treated with intramedullary nail with mean age of 65 years, mean follow-up of 22.2 months and a Constant shoulder score of 72.9 points; the major complications reported were backing out of the screws, shoulder impingement and joint protrusion of the screws.


Antegrade short locked intramedullary nail allows stable fixation, minimal soft tissue dissection, early mobilization of the shoulder and good outcomes. It is an efficacious therapeutic solution for 2- and 3-part proximal humeral fractures.


Shoulder Fractures Proximal humerus Intramedullary nailing Outcomes Treatment 



The authors are grateful to Dr. Marco Verona and Dr. Adriano Demurtas (Clinica Ortopedica, Università degli studi di Cagliari, Italy) for professional support (essential surgical and clinical activity).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the Department of Surgical Science of the University of Cagliari.

Human and animal rights

The retrospective observational study included in this paper involved Human Participants.

Informed consent

Informed consent was obtained from all individual participants.


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Copyright information

© Istituto Ortopedico Rizzoli 2019

Authors and Affiliations

  1. 1.Clinica OrtopedicaUniversità degli Studi di CagliariCagliari, SardegnaItaly

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