Extended Neviaser Portal Approach to Antegrade Humeral Nailing

Dilisio, Matthew F.; Fitzgerald, Ryan; Miller, Eric T.

doi:10.3928/01477447-20130122-30

Cited by 9 publications

(5 citation statements)

References 21 publications

(24 reference statements)

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“…Because of the limitations of current surgical techniques we adapted the technique introduced by Dilisio [5] and Knierim et al [6]. Using the portal of Neviaser the problem of a lateral entry point that puts the supraspinatus tendon at risk was Male patient, 57 years, sustained a diaphyseal spiral fracture after a fall from stairs (1a).…”

Section: Discussionmentioning

confidence: 99%

“…This approach was first used by Dilisio et al in one patient with bilateral fractures and cuff arthropathy. The authors limited the indication to diaphyseal humeral fractures when access to the anterolateral starting port was not possible due to distorted shoulder anatomy [5]. The applicability was confirmed by Knierim et al in 15 cadaver specimens.…”

Section: Introductionmentioning

confidence: 99%

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The portal of Neviaser: a valid option for antegrade nailing of humerus fractures

et al. 2020

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Introduction: The objective of this retrospective non-randomized study was to evaluate the portal of Neviaser (PN) as an alternative approach in antegrade humeral nailing. Methods: The surgical approach for the straight antegrade intramedullary nail (SAIN) was either the anterolateral delta-split (group 2, n = 79) or the portal of Neviaser (group 3, n = 27). Length of surgery and time of radiation were extracted from charts. Patients stabilized using the PN were followed for a clinical and radiological exam. At follow-up we evaluated the DASH (Disability of the Arm, Shoulder and Hand) and CMS (Constant-Murley Score). Results: Between 10.2015 and 12.2018 191 proximal and diaphyseal humeral fractures were operated using either an angular stable extramedullary device (group 1, PHILOS®, n = 85) or a straight humeral nail (MultiLoc®, n = 106). Time of radiation and intervention followed a normal distribution. The mean length of surgery was 172.9 min (SD 91.5) in group 1, 121.5 min (SD 54.1) in group 2 and 96.4 min (SD 33.7) in group 3 (p < 0.01). Time of radiation was significantly different with 1.1 min (SD 0.6: group 1), 3.1 min (SD 1.6: group 2) and 2.9 min (SD 1.7: group 3) (p < 0.01). After a mean interval of 21.5 months (range 6-43 months) 14 / 27 patients of group 3 were available for a clinical and radiological follow-up. The mean DASH in group 3 was 25, the CMS reached 70. The age and sex weighted CMS mean value was 96%. Forward flexion was 131°, abduction 125°. The ratio of strength affected versus non-affected side was 4.4: 6.2 kg. Conclusions: The portal of Neviaser is a feasible and safe approach and is an alternative to the anterolateral delta-split. Length of surgery and time of radiation were significantly shorter.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The portal of Neviaser: a valid option for antegrade nailing of humerus fractures

et al. 2020

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“…On the other hand, Knierim et al 5 first reported the method of antegrade humeral nail insertion via the Neviaser portal in their cadaveric study and showed that this method may reduce the risk of tendon cuff injury, because all the insertions are performed through the supraspinatus muscle belly. Later, Dilisio MF et al 7 reported for the first time the clinical case of bilateral humeral shaft fracture which was treated with this method, because the patient already suffered from rheumatoid arthritis and cuff tear arthropathy and it was not possible to insert the nail by using the traditional anterolateral approach.…”

Section: Discussionmentioning

confidence: 99%

“…Knierim et al 5 suggested, after studying fresh cadavers, that insertion of a short humeral nail is possible percutaneously via the Neviaser portal (medial from the medial border of the acromion and posterior to the acromioclavicular joint), 6 which is more posterior and medial to the anterolateral portal. Dilisio MF et al 7 reported the first case with bilateral humeral shaft fractures, which was treated with antegrade humeral nailing via the Neviaser portal (the Neviaser method). However, to our knowledge, no cases have been reported so far regarding the treatment of proximal humeral fracture with the Neviaser method.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of intramedullary nail fixation via the Neviaser portal for proximal humerus fracture

Tanaka

Gotani

Sasaki

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Objectives: To our knowledge, no cases have been reported so far regarding the treatment of proximal humerus fracture with intramedullary nail fixation via the Neviaser portal. This study aimed at evaluating the results of intramedullary nail fixation via the Neviaser portal for proximal humerus fracture. Methods: Four patients with 2-part proximal humerus fracture, who underwent the intramedullary nail fixation via the Neviaser portal, were included in this study. All the patients were females, and the mean age was 78.8 years. We evaluated their clinical and radiographic findings retrospectively. Results: The mean follow-up period was 12 months. All the patients achieved a bone-union without severe complications, such as deep wound infections or any neurological deficits. At the final follow-up, mean shoulder flexion, abduction, and external rotation were 123.5 , 118 , and 36 , respectively. Mean visual analog pain scale (VAS) score at the final follow-up was 21/100. Complications related to the implants were observed in two patients. In one patient, protrusion of the proximal tip of the nail occurred from the entry point, and this caused secondary subacromial impingement. In the other patient, insertion of the end-cap from the Neviaser portal was not possible, and this resulted in the failure of fixation postoperatively. Conclusion: The Neviaser portal may be suitable for the insertion of an intramedullary nail, because it facilitates to make an entry-point at the top of the humeral head. However, the problems related to the use of the present instruments still remain and need to be improved.

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“…Dilisio et al (2017) describe the socalled "Neviaser Portal Approach" as access for antegrade humerus medullary nailing, when the rotator cuff is already damaged (cuff arthropathy) or in rheumatoid arthritis, which would impede anterolateral access. The extended traditional superomedial access to the shoulder for antegrade humerus medullary nailing was first described by these authors in a case report [23]. Four years previously, Knierim et al had reported a cadaver study which described the successful use of percutaneous nail insertion through the classical Neviaser portal, in order to avoid persistent postoperative shoulder pain.…”

Section: Discussionmentioning

confidence: 99%

A Modified Rotator Cuff Sparing Approach to the Proximal Humerus in Antegrade Nail Osteosynthesis with Transosseous Supraspinatus Tendon Refixation

et al. 2019

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Background Due to the approach within antegrade humerus nail osteosyntheses, lesions of the supraspinatus tendon with a consecutive functional limitation of the rotator cuff (RC), insufficiencies, adhesions and chronic shoulder pain in the long term can result. The evidence respectively the study data situation is limited regarding the evaluation of this issue. Patients/Material and Methods We are the first to present by means of a case report with a geriatric female patient and a dislocated diaphyseal humerus fracture a rotator cuff sparing osseous approach to the proximal humerus in antegrade nail osteosynthesis without harming the vulnerable supraspinatus tendon (SSP). This is possible through a limited osteotomy of the greater tubercle with the preparation of a 10 mm deep and 15 to 20 mm wide osseous SSP base. The medullary cavity is then opened for inserting the nail in an antegrade manner and closed after fracture stabilization through reposition of the attached osteotomy of the greater tubercle by means of a suture anchor, for example. The procedure also includes a biceps tenodesis. Besides the description of the intraoperative approach and procedure, the clinical and functional results were recorded by established scores as well as radiologically respectively sonographically 6 weeks (T1) and 3 months (T2) postoperatively. Results The patient was very satisfied regarding pain and function after the modified operative procedure. The rotator cuff tests were negative and there were no impingement like symptoms or indications for an adhesive capsulitis. Range of motion as well as the Constant and (Quick) DASH-Score showed a very good function in the course. The implant was located regularly in the radiological control and the fracture showed a good osseous consolidation. A bland joint without effusion or periarticular fluid and no adhesion with the delta fascia could be presented by sonography. The RC and especially the SSP showed a normal sonographic separation. The functional results are comparable to the other publications so far. Conclusion The described surgical technique shows a significantly less invasive approach for the implantation of an antegrade humerus nail in the case of a humerus shaft fracture with an excellent function of the affected shoulder in a short-term follow-up. This novel approach should be evaluated by means of prospective studies regarding the functional outcome to justify the establishment of this modified procedure in the long term. Other modified approaches have been depicted but are essentially differing from our described procedure with regards to the invasiveness of the vulnerable tendinous structure of the SSP respectively RC.

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Extended Neviaser Portal Approach to Antegrade Humeral Nailing

Cited by 9 publications

References 21 publications

The portal of Neviaser: a valid option for antegrade nailing of humerus fractures

The portal of Neviaser: a valid option for antegrade nailing of humerus fractures

Evaluation of intramedullary nail fixation via the Neviaser portal for proximal humerus fracture

A Modified Rotator Cuff Sparing Approach to the Proximal Humerus in Antegrade Nail Osteosynthesis with Transosseous Supraspinatus Tendon Refixation

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