Arthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus

Abstract

ArticleArthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus Sü leyman Semih Dedeog lu, Yunus _ Imren, Haluk Ç abuk, Ali Ç ag rı Tekin, Mustafa Ç ag lar Kır and Hakan Gü rbü z Abstract Purpose: The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intraarticular complication rates as well as on clinical and functional outcomes. Methods: This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n ¼ 20) or conventional (Intramedullary nailing [IMN]; n ¼ 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) score. Results: Groups did not significantly differ in terms of age, gender, and mechanism of injury, length of hospital stay, union rate, and mean union time (p > 0.05). Mean ASES and Constant scores were found to be statistically significantly higher in AIMN group than that in IMN group (p ¼ 0.000 and p ¼ 0.002, respectively). Mean number of fluoroscopic shootings until the guide wire was inserted was 2.15 in AIMN group, which was significantly lower compared to 4.2 of IMN group (p ¼ 0.000). Conclusions: Arthroscopy-assisted technique may be an applicable and safe method owing to its cosmetic advantages and more satisfactory postoperative shoulder functions subsequent to less injury to deltoid, rotator cuff, and other soft tissue, as compared to conventional anterograde approach.

Measures of Adult Shoulder Function

“…The ASES was used in 43 randomized clinical trials up to the end of 2015 (2). It remains extremely popular and has been used in at least 35 trials in the last 5 years, including the following: Double‐ versus single‐row rotator cuff repair (84) Steroid injection versus arthroscopic capsular release for early stage adhesive capsulitis (85) Rotator cuff repair with and without distal clavicle resection (86‐88) Relaxation exercises to reduce postoperative pain after rotator cuff repair (89) Subacromial autologous–conditioned plasma versus glucocorticoid for symptomatic partial rotator cuff tears (90) Subacromial autologous platelet‐rich plasma versus glucocorticoid for symptomatic partial rotator cuff tears (91) A 135 degree versus a 155 degree reverse arthroplasty prosthesis for rotator cuff arthropathy (92) Liposomal bupivacaine versus continuous peripheral nerve block following arthroplasty (93) Glucocorticoid injection versus oral nonsteroidal anti‐inflammatory drugs (NSAIDs) for adhesive capsulitis (94) A 12‐month exercise program versus usual care after rotator cuff repair (95) Multimodal analgesia injection combined with glucocorticoid versus saline injection after arthroscopic rotator cuff repair (96) Interference screw versus suture anchor fixation for biceps tenodesis (97) Optimum versus maximum tension–bridging suture for rotator cuff repair (98) Platelet‐rich plasma after rotator cuff repair (99) Arthroscopic versus open stabilization for anterior shoulder subluxation (100) High‐ versus low‐dose intra‐articular glucocorticoid for shoulder stiffness (101) Triple‐loaded single‐row versus suture‐bridging double‐row (20) rotator cuff repair augmented with platelet‐rich plasma fibrin membrane (102) Arthroscopic rotator cuff repair with and without biceps tenodesis, using the percutaneous intra‐articular transtendon technique (103) Pulley exercises versus rehabilitation without pulleys after rotator cuff repair (104) Open versus arthroscopic rotator cuff repair (105) Biceps tenotomy versus biceps tenodesis (106) Intramedullary nail versus locking plate for proximal humeral fracture (107) Arthroscopy‐assisted versus standard intramedullary nail fixation for diaphyseal humerus fractures (108) Reverse total shoulder arthroplasty as primary procedure versus revision procedure for proximal humerus fractures (109) Propri...…”

Arthroscopic intramedullary nailing of humeral fractures through the rotator interval

“…The absence of intraoperative and postoperative compilations means the technique itself is not iatrogenic. Neither of the two previous studies of humeral nailing by arthroscopy found more complications when using arthroscopy compared to the standard open technique [10,11], just like the published studies of arthroscopic nail removal [22,23].…”

“…Nine patients had a surgical neck fracture, six had a mid-shaft fracture and three had both surgical neck and mid-shaft fractures. The mean time between the injury event and the procedure was 8.9 days (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The mean operative time was 61 minutes (36-93).…”

“…In 2017, Dedeoglu et al [11] published a prospective randomized study of arthroscopic nailing. Forty patients were enrolled into two groups that underwent either standard IM nailing (n=20) or arthroscopic nailing (n=20).…”

“…In 2017, Christ et al [9] added tenotomy-tenodesis of the long head of biceps. Lill et al in 2012 [10] and Dedeoglu et al in 2017 [11] published two studies on arthroscopic humeral nailing in which the nail was inserted through an incision in the supraspinatus tendon.…”