Antegrade nailing evolution for proximal humeral fractures, the Telegraph IV(®): a study of 67 patients.

Introduction: There are multiple surgical treatment methods for proximal humerus fractures (PHF), but rarely do they provide satisfactory results. The objective of this study was to assess radioclinical outcomes and complications in patients treated using a modern intramedullary nailing system the Telegraph I(®).
Materials and Methods: This is an observational multicenter study cohort conducted between March 2008 and December 2009 on 105 patients admitted with a diagnosis of PHF and operated on two trauma I centers. The Neer and Articular Surgical neck Tuberosities classifications were used for the study. The primary outcome measure was the clinical Constant score. Follow-up of the patients was done at 6 weeks, 3 months, 6 months, 1 year, and 3 years after the procedure.
Results: A total of 67 patients (51 women and 16 men) were assessed at a mean of 38 months. The weighted Constant score was 88%. The mean rate of complications was 16%. The weighted Constant scores were 84 and 95% for the 2- and 3-part groups, respectively. Articular 4-part fractures had an average score of 86% when they were valgus impacted and 67% for complex disengaged fractures. Notably, the complication rate was 67% for this latter group.
Conclusions: Our clinical results support the use of this antegrade nailing for extra-articular and valgus-impacted articular fractures. This procedure does not appear suitable for displaced articular fracture for which arthroplasty may be indicated by elderly.