[The long Telegraph nail for humeral fractures]. / Le clou Telegraph long dans les fractures de l'humérus.

PURPOSE OF THE STUDY: We present an anterograde nailing system for humeral shaft fractures: the long Telegraph(R) nail. This nail enables static or dynamic anteroposterior distal locking and is easy to insert with the special aiming device. MATERIAL AND METHOD: This study concerned 148 patients who underwent surgery between September 1998 and February 2005, 86 women, men age 68 years and 62 men, mean age 53 years. After excluding patients lost to follow-up and pathological fractures, we analyzed 104 files to determine the rate of nonunion as a function of distal locking or not and dynamic versus static locking. We also reviewed 56 patients measuring the Constant score at mean 2.7 years follow-up. RESULTS: There were no cases of iatrogenic radial palsy and no cases of infection. There were four cases of nail fracture. The overall rate of nonunion was 7.7%. Nonunion was never observed with dynamic distal locking (p=0.03). Regarding the effect of the nail on shoulder function, the mean weighted Constant score was 105.4% with preservation of mean joint motion and a pain free shoulder in 36/56 patients. DISCUSSION: The long Telegraph(R) nail enables anterograde nailing of the humeral shaft with a simplified system for dynamic or static distal locking. In this series, dynamic distal locking appeared to provide the best rate of nonunion. If installed correctly, the system does not appear to affect shoulder function.

[Proximal 4-part humerus fractures treated by antegrade nailing with self-stabilizing screws: 31 cases]. / Fractures à quatre fragments de l'humérus proximal traitées par enclouage léger antérograde à vis autostables: à propos de 31 cas.

PURPOSE OF THE STUDY: We present results of an internal fixation procedure for 4-part fractures of the upper part of the humerus with or without impaction. MATERIAL AND METHODS: Antegrade nailing with self-stabilizing screws, by Telegraph nail, was used in 31 patients treated between June 1998 and June 1999. The standard insertion technique or the cup-and-ball method were used for nail insertion depending on the type of fracture (Neer and Duparc classification), the cup-and-ball method allowing fixation of more complex fractures. Clinical and radiological data were available for 23 patients at a mean follow-up of two years. Functional outcome was assessed with the Constant score. RESULTS: At last follow-up, the rough Constant score was 63 and the age- and sex-balanced Constant score was 85. Mean antepulsion was 130 degrees. Outcome was significantly better for Duparc type 2 cephalotuberosity fractures (scapula valga) where the weighted Constant score was 93. There were two cases of necrosis. DISCUSSION: Complex fractures of the upper part of the humerus are a major therapeutic challenge. To date, there is no agreement on the most appropriate osteosynthesis method and the results of shoulder prosthesis after trauma remain controversial. The Telegraph nail appears to be a simple and reproducible method of achieving reduction, stability, and early mobilization. Functional outcome has been favorable for type 2 cephalotuberosity fractures and only two cases of necrosis were observed in this series in patients with type 3 and 4 cephalotuberosity fractures. These good results are related to the self-stabilizing effect of the locking screws which allow a stable fixation and revascularization of the bony fragments by creeping substitution. This new system is an attractive alternative to shoulder prostheses in trauma victims with complex displaced fractures without impaction. The surgical technique remains difficult. It would appear reasonable to expect remarkable and reproducible results for impacted fractures.

[A new locking nail for proximal humerus fractures: the Telegraph nail, technique and preliminary results]. / Un nouveau clou verrouillé pour les fractures proximales de l'humérus.

We present a new nail, the telegraph nail, designed for the treatment of proximal fractures of the humerus. This nail has a new locking system providing a self-stabilization of the cancelous screws inserted in small fragments. We discuss the surgical technique and present preliminary results. The anterolateral approach and nail insertion through the medial and well vascularized part of the cuff is described for simple fractures. With the cup and ball technique, this nail can also be used for complex fractures of the proximal humerus with three or four fragments and major displacement. With this method, the nail is inserted before reduction and locked in the distal humerus before fixation of the head and tuberosities around the head once the targeting device removed. We report results for the first 64 nails inserted in our unit during the first year (1998-1999). Outcome was assessed at 11 months mean follow-up using the Constant score. Outcome was favorable, including in patients with complex fractures involving 3 or 4 separate displaced fragments. Besides providing an anatomically stable reconstruction, the telegraph nail has the advantage of allowing early mobilization of the shoulder joint. This method is a useful alternative to prosthetic reconstruction for traumatic fractures of the proximal humerus.