telegraph nail

First series :

June 1998 to June 2000
88 women (72 %)
Aged : 69 years (15 to 92)

These are the first cases registered at the Bon Secours hospital in Metz between June 1998 and June 2000.

First series 123 cases :

Surgical Neck : 61%

Articular valgus impacted : 18%

Articular complex & dislocated : 21%

123 cases were examined . They were classified according to anatomical characteristics.

First series 123 cases

SURGERY
Average time 3 days (0 à 21)
71 % 7 mm nails
18 % ball-and-sockets
58 % immediate mobilizations

This osteosynthesis system was soon notified to be of particular interest. Therefore, in order to analyse in a better way the results, we published this prospective study sheet of proximal humerus fractures using the TELEGRAPH nail.

The first side of this simple two-sides sheet shows patient, fracture and operation data. On the back side the Constant used score column shows functional shoulder recovery.

In this matter, and excluding the necrosis problem, the results were systematically admitted after six months.

CONSTANT SCORE
78 cases 26 deaths, 19 losses 4 years (42 to 55 months)

Rough score : 65.5

Weighted (age & sex) score : 88 %

Global score of the complete serie. 78 cases to be re-examined in 4 years.

CONSTANT SCORE
4 years (p > 0.05)

Surgical Neck : 61% ( percutaneous)
93.5%
Articular valgus impacted: 18%
85%
Articular complex & dislocated: 21%
77.5%

Results depending on the anatomical type.

COMPLICATIONS

3 early re-operations
1 sepsis
3 late displacements (selfstable screws)
23 device removals
(for impingment)
8 avn (27% of articular fractures)

The origin of the main complication was the need of device removal, either because of a too long screw, or because of a screw insufficiently low. Or finally because of the raising of the nail due to the impaction of the fracture seat (static fitting)

8 NECROSES
4 years (p < 0.05)

Surgical Neck : 61% --> 0 (0%)

Articular valgus
impacted : 18% --> 2 (15,5%)

Articular complex
& dislocated : 21% --> 6 (37,5%)

Classification of the necroses according to the anatomical type.

Example of a successful treated necrosis.

8 NECROSES
Constant: 40 (27 to 64) (56%)

No Prosthesis in this series

Constant score of these 8 necroses.

NECROSES Constant : 87% ???

K. C. LEE et all - The Journal of Trauma - 1981
Post-traumatic Avascular Necrosis of the Humeral Head in Displaced proximal Humeral Fractures.

« Creeping substitution »

These results can be explained by the « Creeping substitution » described by Lee: in case of fracture with great displacements, most of the humeral heads are necrosed but can quickly be re-vascularized. This applies only if the rotator cuffs remain complete further to a solid fitting.

Necrosis Risk
� Prosthesis

« Creeping Substitution »

According to this serie, the risk of necrosis doesn't justify the use of prostheses.

This technique seemed to be :

Reliable for
+ 2 - part fractures
+ 3 - part fractures
+ 4 - part valgus impacted fractures

Difficult but possible with experience for
+ higly complex fractures
+ instead of prosthesis

On the whole, this technique seems advisable and reproducible for 2 and 3 fragments fractures as well as for 4 fragments valgus-impacted fractures. Although it seems difficult for the treatment of complex fractures, this technique remains possible as an alternative to traumatic prostheses further to experiments.

Our indications are :