Clinical Observation of Intramedullary Twisted Elastic Nail in the Treatment of Proximal Humerus Fractures in the Elderly

Dai Jian; Li Zhaohui; Zhu Siwen; Zhu Dongrun; Chen Wei; Nie Weizhi

Abstract：Objective The clinical data of intramedullary titanium elastic nail(TEN)support reduction and fixation and open reduction and internal fixation(ORIF)of bone plate in the treatment of elderly proximal humerus fractures were compared and the advantages of efficacy were discussed.Methods A retrospective analysis was conducted on 802 elderly patients with proximal humeral fractures admitted to Wendeng Orthopaedic Hospital in Shandong Province from January 2013 to December 2023.The patients were divided into two groups based on the surgical procedure:The TEN group,comprising 401 patients(165 males and 236 females)with ages ranging from 60 to 89 years,and an average age of(74.42±8.83)years;And the ORIF group,also comprising 401 patients(189 males and 212 females)with ages ranging from 60 to 91 years,and an average age of(74.62±8.79)years.General patient information and intraoperative data(including surgery duration,intraoperative blood loss,and incision length)were recorded.Pain levels were assessed using the visual analogue scale(V AS),shoulder joint range of motion(ROM)was measured with a goniometer,and shoulder function recovery was evaluated using the Constant-Murley shoulder function score.Postoperative X-rays were regularly reviewed to observe fracture healing time and complications after discharge.Results All patients were followed up for a period ranging from 3 to 6 months,with an average follow-up time of(5.80±0.34)months.Both surgical approaches achieved good treatment outcomes,with all fractures healing without significant complications such as nerve damage or infection.The TEN group showed superiority over the ORIF group in terms of surgery duration,incision length,blood loss,and fracture healing time,with statistically significant differences(P＜0.05).On the first postoperative day,there was no statistically significant difference in VAS pain scores between the two groups.However,at 7 and 30 days postoperatively,the VAS pain scores in the TEN group were slightly lower than those in the ORIF group(P＜0.05).One month postoperatively,the ROM and Constant-Murley function scores were higher in the TEN group compared to the ORIF group,with statistically significant differences(P＜0.05).However,there was no statistically significant difference between the two groups at 3 months postoperatively(P＞0.05).These findings suggest that while both surgical methods are effective in treating proximal humeral fractures in elderly patients,the TEN approach may offer advantages in terms of reduced surgery time,incision length,blood loss,and earlier pain relief and functional recovery,at least in the short term.Conclusion The treatment of elderly proximal humeral fractures with intramedullary torsion elastic nails has less trauma,good efficacy,fast recovery and high reliability,which is more conducive to the early rehabilitation of patients.During the operation,the elastic nail not only plays a role in reduction,but also plays a fixed role,reducing the surgical procsss It is an excellent surgical method and is worthy of promotion.