In third-generation humeral intramedullary nailing of proximal humerus fractures, a more medial and posterior starting point improves alignment, and alignment improves with surgeon experience.

@article{qubain2026thirdgeneration,
  title = {{In third-generation humeral intramedullary nailing of proximal humerus fractures, a more medial and posterior starting point improves alignment, and alignment improves with surgeon experience.}},
  author = {Leeann Qubain and Muhammad Umar Jawad and Matthew Eisenberg and Midhat Patel and Michael H Amini},
  journal = {JSES reviews, reports, and techniques},
  year = {2026},
  month = sep,
  doi = {10.1016/j.xrrt.2026.100880},
  url = {https://europepmc.org/article/MED/42904069},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - In third-generation humeral intramedullary nailing of proximal humerus fractures, a more medial and posterior starting point improves alignment, and alignment improves with surgeon experience.
AU  - Leeann Qubain
AU  - Muhammad Umar Jawad
AU  - Matthew Eisenberg
AU  - Midhat Patel
AU  - Michael H Amini
PY  - 2026
DA  - 2026/09/11
JO  - JSES reviews, reports, and techniques
DO  - 10.1016/j.xrrt.2026.100880
UR  - https://europepmc.org/article/MED/42904069
AB  - Background  This study evaluates how the start point of a third-generation humeral intramedullary nail (IMN) for proximal humerus fractures (PHFs) affects radiographic fracture alignment and whether surgeon experience improves radiographic alignment over time.Methods  Retrospective review of patients over 18 years old with PHFs treated with IMNs by a single surgeon between March 2021 and October 2023. The senior author reduced the fracture before fixation with a third-generation short proximal humeral nail with a lateral Herzog bend (Stryker). On the anterior-posterior (AP) view, we measured the distance from the start point to the lateral articular margin and the lateral edge of the head in millimeters (mm) and as a ratio relative to the width of the head. On the lateral view, we measured the distance from the start point to the anterior edge of the head in mm and as a ratio relative to the width of the head. We measured angulation and translation relative to the shaft on the AP and lateral views. "Acceptable" reductions were defined as neck shaft angle (NSA) > 130° and translation <20% on the AP view, and angulation from -5° to 5° and translation <20% on the lateral view. Logistic and linear regressions were used to correlate start point measurements with reduction parameters. Receiver operating characteristic curve was used to determine the cutoff start point on AP and lateral radiographic views, resulting in adequate reduction.Results  Thirty-three of 34 patients met the inclusion criteria. On the AP view, a more medial start point was associated with increased NSA (β = 0.34, P = .030) and a lower OR of residual varus alignment (odds ratio [OR]: 0.87; P = .045). On the lateral view, a more posterior start point was associated with avoiding translation >20% (OR: 0.57; P = .017). Receiver operating characteristic curve analysis revealed that a start point at least 4.2 mm medial to the lateral articular margin resulted in NSA >130 with 80% sensitivity and 75% specificity (area under curve [AUC] 0.76). On the lateral view, a start point at least 18.2 mm posteriorly would result in <20% translation with 81% sensitivity and 86% specificity (AUC: 0.85). Reductions improved over time, with a lower rate of varus alignment after 12 cases.Conclusion  When treating PHFs with IMN, a start point that is more medial and posterior improves angulation and translation. There is a learning curve with a lower rate of varus alignment after 12 cases.
SN  - 2666-6391
ER  -