Clinical outcomes following intramedullary nailing of humerus fractures: a systematic review.
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2025-07
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Abstract
Background
The purpose of this study is to systematically review the literature to assess clinical outcomes arising from intramedullary nailing (IMN) of humerus fractures.Methods
Two independent reviewers performed a literature search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on patient-reported outcomes and range of motion following the use of IMN for humerus fractures between 2000 and 2023.Results
A total of 88 studies, including 4255 patients, met the inclusion criteria for review. The majority of patients were female, with a mean age of 58.3 ± 12.4 years and a mean follow-up of 21.2 ± 15.2 months. The primary outcome score utilized for postoperative assessment was the Constant-Murley Score (CMS). The mean CMS for all fractures, proximal humerus fractures (PHFs), and humeral shaft fractures were 74.7 ± 12.5, 74.2 ± 12.3, and 77.3 ± 12.1, respectively. The mean CMS in 2-part, 3-part, and 4-part PHFs was 80.8 ± 8.8, 80.4 ± 12.3, and 66.5 ± 11.3, respectively. The primary range of motion measurements measured for postoperative assessment were forward flexion and external rotation. The mean forward flexion for all fractures, PHFs, and humeral shaft fractures was 135° ± 16°, 131° ± 13°, and 143° ± 18°, respectively. The mean external rotation for all fractures, PHFs, and humeral shaft fractures was 46° ± 15°, 43° ± 13°, and 52° ± 16°, respectively.Conclusion
IMN for humerus fractures provides good functional outcomes in both proximal humerus and humeral shaft fractures. However, functional outcomes in PHFs decreased as the number of displaced fracture parts increased.Type
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Adu-Kwarteng, Kwabena, Eoghan T Hurley, Kiera Lunn, Jessica M Welch, Tom R Doyle, Jay M Levin, Oke Anakwenze, Yaw D Boachie-Adjei, et al. (2025). Clinical outcomes following intramedullary nailing of humerus fractures: a systematic review. JSES international, 9(4). pp. 1021–1028. 10.1016/j.jseint.2025.02.009 Retrieved from https://hdl.handle.net/10161/34798.
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Scholars@Duke
Oke Adrian Anakwenze
Complex shoulder and elbow surgeon, researcher and innovator.
Yaw Boachie-Adjei
Christopher Scott Klifto
Christopher S. Klifto grew up outside Philadelphia. He graduated from Carnegie Mellon University where he received a degree in Chemical and Biomechanical Engineering. He received his medical degree from Rutgers-Robert Wood Johnson Medical School, and completed his Orthopaedic residency and Hand and Upper Extremity fellowship at NYU- Hospital for Joint Diseases.
Dr. Klifto is an orthopaedic surgeon specializing in upper extremity. He treats orthopaedic conditions for the shoulder and elbow including arthritis, rotator cuff injuries, labral tears, frozen shoulder, sports injuries, fractures, tendon injuries, cubital tunnel syndrome. He treats patients both conservatively and surgically; meeting with each patient, hearing their goals and determining the best plan of care together. He specializes in shoulder surgeries such as reverse total shoulder arthroplasty, anatomic shoulder arthroplasty and shoulder hemiarthroplasty. He also performs rotator cuff repair, shoulder labral reconstruction, and shoulder arthroscopy. He treats upper extremity fractures including shoulder and clavicle, humeral shaft, and elbow injuries. He chose orthopaedics from having injuries himself over the years, so he understands what patients are going through when they see him and treat them with as much compassion and respect as possible. "I am very involved in Research, with a particular focus in the shoulder. The research here at Duke is second to none; the best minds are here in one area, all collaborating and trying to figure out how to get better. The most gratifying part of my job is to see patients get back to the level of activity where they would like to be.”
He is a Clinical Associate Professor at Duke University. He has published articles in nationally recognized publications on many conditions of the upper extremity and continues to actively conduct clinical research and contribute to national textbooks.
Dr. Klifto serves as the division lead of shoulder and elbow surgery at the Durham VA in addition to his clinical practice at Duke Orthopaedics/North Carolina Orthopaedic Clinic.
Dr. Klifto lives in Durham with his wife Meredith, an Ophthalmologist. He has three wonderful daughters (Madeline, Anna, and Grace) and a labradoodle named Goose that are the joys of his life. He enjoys golf, fishing, skiing, tennis, kite boarding and professional and collegiate sports.
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