Intramedullary Nailing in Proximal Humerus Fractures: Outcomes Beyond the Simple Two-Part

Background: Proximal humerus fractures (PHFs) are common injuries, particularly in the elderly. While intramedullary nailing (IMN) has gained popularity for treating these fractures, its efficacy in complex cases, especially those with comminuted calcar, remains a topic of debate. This study aimed to evaluate the outcomes of IMN in PHFs with and without calcar comminution. Methods: A prospective observational study was conducted on 40 patients with displaced PHFs treated with IMN. Patients were divided into two groups based on the integrity of the calcar: intact (group A) and comminuted (group B). Radiographic and clinical outcomes were assessed at 3, 6, and 12 months postoperatively. Results: All fractures achieved union. Minimal loss of reduction was observed in both groups, with no significant difference between them. Functional outcomes, including pain, range of motion (ROM), and patient -reported scores, improved over time in both groups. Patients with intact calcar showed significantly better outcomes in terms of Simple Shoulder Test (SST) score and forward elevation at all follow-up points. The complication rate was low (2.5%), with one case of osteonecrosis in group A. Conclusion: IMN is a safe and effective treatment for displaced PHFs, even with comminuted calcar. Although calcar comminution may lead to slightly worse outcomes in specific functional parameters, the overall impact is minimal. IMN offers a viable alternative to plate fixation, particularly in complex fractures, with favorable outcomes and a low complication rate.