Basic principles of the nail stability in proximal humerus fractures fixation

Antegrade nailing has been established as a valid option of treatment in proximal humeral fractures which follows the concepts of minimum invasive surgery. Displaced three-and four-part fractures generally require a more extensive approach. The design of the modern nails is based on five principles: medial articular insertion point, fixation of the tuberosities, supporting the humeral head, angular-stable locked screws, stable fixation and centering within the medullary canal. But the outcome of the surgical procedure essentially depends on the adequate intraoperative management of the specific features of the fracture type.The purpose of this article was to analyze the use of intramedullary nails for proximal humerus fracture and to identify the key points in the surgery technique to improve treatment results.Conclusion: The technique of osteosynthesis with a proximal humeral nail in compliance with the algorithm is simple, low-traumatic and fast, and also allows to achieve the highest level of stability in fractures of the proximal humerus even with a decrease in bone density. It is mandatory to neutralize the forces of the rotator cuff by suturing and reinforcing the tubercles on the basis of a metal implant. The anterolateral approach allows excellent intraoperative reduction and additional suture fixation of tuberosities when the pure screw fixation does not provide enough stability.