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The intramedullary nail has gained acceptance as an alternative to plate fixation for proximal humeral fractures as a result of improved implant design with an advantage of preserving fracture site vascularity which helps promote healings. Although historic indications for use of nail fixation have been focused on pathological and displaced 2-part fractures, sufficient outcome data for more complex fractures have allowed indications to expand to include fractures with tuberosity fracture segments (3and 4-part fractures). Meticulous attention to radiographic imaging is critical for accurate nail placement, avoiding the rotator cuff footprint, and anatomic tuberosity fixation. In general, published reports tend to support nail fixation as having equivalent outcomes to plate fixation with a relatively low complication rate.

Intramedullary nailing of the proximal humerus—not just for 2-part fractures