Fixation von Humeruskopffrakturen mit anterograder Marknagelung

Abstract

The new method of antegrade intramedullary fixation of humeral head fractures is based on a straight proximal humeral nail with special head fixation screws and conventional interlocking screws at the proximal end of the shaft fragment leaving an axillary nerve shelter space in between. The nail acts as a central load carrier. The head fixation screws run through threaded holes in the proximal end of the nail thus being held in a stiff angle and without gliding. The entry points of these screws correspond to the anatomical main portions of the lesser and greater tubercle. They allow a three-dimensional screw grip to the subchondral bony layer of the head fragment. The purpose of this intramedullary construct is to keep the fracture stable at a grade which allows instant postoperative active exercise and which corresponds to the needs of mechanical tranquility in a predominantly endosteal healing area. In a prospective clinical study 45 patients could be followed up after 3, 6 and 12 months. We found an ongoing improvement of the postoperative results up to an average Constant Score of 85.7 pts after one year. The complication rate was 16 %. The main complication was the screw protrusion into the joint.

Beeinflusst die Kooperationsfähigkeit das funktionelle Resultat operativ behandelter proximaler Oberarmfrakturen im Senium?

“…tiv (Typ A -C nach AO, winkelstabile Platte, proximaler Humerusnagel), so werden Werte von 62 -85,7 Punkten angegeben [3,5,8,9,17,18]. …”

Osteosynthese instabiler proximaler Humerusfrakturen mit dem Targon®-PH-Nagel

“…Nail fixation of the humerus is not new [7,9,11] but is experiencing a renaissance, partly due to the availability of fixed-angle implants and optimized targeting devices for nail locking [1,5,6,8,10]. The introduction of several proximal locking options at various angles to each other, which permit fixed-angle and nongliding nail locking, has increased the stability of screw fixation in the osteoporotic humeral head.…”

“…winkelstabilen Implantaten und optimierten Zielbügeln für die Verriegelung eine Renaissance [1,5,6,8,10]. Durch die Einführung von mehreren proximalen Verriegelungsoptionen in unterschiedlichen Winkeln zueinander, die zudem winkel-und gleitstabil im Nagel zu verankern sind, erhöht sich die Stabilität der Fixierung im osteoporotischen Humeruskopf.…”

Fixation of Proximal Humeral Fractures with an Intramedullary Nail: Tipps and Tricks

“…Various types of intramedullary devices have been introduced into clinical use for proximal humeral fractures during the last decade [1][2][3][4][5][6][7]. Many nail constructs rely on a spatial arrangement of the screws fixing the head fragment.…”

“…Many nail constructs rely on a spatial arrangement of the screws fixing the head fragment. Parallel to the development and refinement of locking plates the principles of angular stability have been realized in intramedullary interlocking nailing of the proximal humerus, as well [4]. This constructional feature proved to be favorable in particular in osteoporotic fractures [8].…”