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Angular-Stable Locked Intramedullary Nailing of Two-Part Surgical Neck Fractures of the Proximal Part of the HumerusA Multicenter Retrospective Observational Study
Armodios M. Hatzidakis, MD1; Michael J. Shevlin, MD2; Duane L. Fenton, PA-C1; Douglas Curran-Everett, PhD3; Robert J. Nowinski, DO4; Edward V. Fehringer, MD2
1 Western Orthopaedics, PC, 1830 Franklin Street, Suite 450, Denver, CO 80218. E-mail address for A.M. Hatzidakis: Armandhatzi@yahoo.com
2 University of Nebraska Medical Center, 987830 Nebraska Medical Center, Omaha, NE 68198-7830
3 Division of Biostatistics and Bioinformatics, M222, National Jewish Health, 1400 Jackson Street, Denver, CO 80206
4 OrthoNeuro, 7277 Smith's Mill Road, Suite 300, New Albany, OH 43054
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at Western Orthopaedics, PC, Denver, Colorado, OrthoNeuro, New Albany, Ohio, and the University of Nebraska Medical Center, Omaha, Nebraska

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Dec 07;93(23):2172-2179. doi: 10.2106/JBJS.J.00754
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The ideal fixation technique for the treatment of proximal humeral fractures remains unclear. In the present study, we evaluated the experience of three surgeons with the treatment of two-part surgical neck fractures with angular-stable intramedullary fixation.


Forty-eight patients with forty-eight Neer two-part surgical neck proximal humeral fractures were managed with locked angular-stable intramedullary nail fixation by three surgeons. Shoulder pain and outcomes were quantified with Constant scores and standard radiographs.


Thirty-eight patients (including twenty-eight female patients and ten male patients) with a mean age of sixty-five years were followed for at least twelve months (mean, twenty months; range, twelve to thirty-six months). All fractures healed primarily. The mean follow-up Constant score (and standard deviation) was 71 ± 12 points (range, 37 to 88 points), with a mean age-adjusted Constant score of 97% (range, 58% to 119%). The mean Constant pain score was 13 ± 2.2 (possible range, 0 to 15 points, with 15 points representing no pain). The mean forward flexion was 132° ± 22°. All fractures but one healed with a neck-shaft angle of ≥125°.


Patients who were managed with locked angular-stable intramedullary nailing of two-part surgical neck proximal humeral fractures via an articular entry point had reliable fracture-healing, favorable clinical outcomes, and little residual shoulder pain.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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