Background: Intramedullary angular and sliding stable interlocking nails are attracting increasing attention in the treatment of fractures of the proximal humerus. This prospective study evaluates the clinical and radiological outcome of the "Varion" nail osteosynthesis system. Additionally we analysed the impact of the postoperative head-shaft angle on the functional outcome.
Patients and methods: We examined 61 patients who were treated with a Varion nail and were re-evaluated after an average follow-up period of 7.1 months. We assessed the pre-trauma DASH score and the Constant score of the non-injured side. We also measured the postoperative radiographic head-shaft angle. At the follow-up exam we determined the DASH and Constant scores of the treated extremity and made control radiographs.
Results: We were able to re-evaluate 54 patients. The DASH score at follow-up averaged 19.3 and the mean postoperative Constant score reached 67.4 points and thus 81.1 % of the score of the non-injured side. The average pain level was 1.3 on the VAS. A high patient satisfaction was obtained. There was a significant correlation between the complexity of the fracture and the clinical outcome. The best functional result was seen when the postoperative head-shaft angle was between 140 and 151°. There were 7 cases of postoperative complications, in 5 of these cases minor revision surgeries were carried out.
Conclusion: The "Varion nail" provides safe and effective treatment of even complicated proximal humerus fractures with good clinical and functional results. The optimum angle between head and shaft axis lies between 141 and 150°.
Georg Thieme Verlag KG Stuttgart · New York.