Humeral nailing revisited

Rommens, Pol Maria; Kuechle, R.; Bord, Th.; Lewens, T.; Engelmann, R.; Blum, Jochen

doi:10.1016/j.injury.2008.01.014

Cited by 118 publications

(63 citation statements)

References 39 publications

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“…Intramedullary nails are currently the preferred mode of treatment for fractures with associated soft tissue injury, pathologic fracture, diaphyseal segmental fractures, and osteopenic bone. Humeral shaft fractures in elderly patients with poor bone quality is on the rise, particularly in the United States [38,39]. These patients are best treated with a load sharing device.…”

Section: Operative Management Of Humeral Shaft Fracturesmentioning

confidence: 99%

Humeral shaft fractures

Spiguel

Steffner

2012

Curr Rev Musculoskelet Med

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Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

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Section: Operative Management Of Humeral Shaft Fracturesmentioning

confidence: 99%

Humeral shaft fractures

Spiguel

Steffner

2012

Curr Rev Musculoskelet Med

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“…The incidence of non-unions in bones of the extremities is as follows: the tibia has on average an occurrence of 8.7% (6,7), the femur only slightly less at 6.1% (8)(9)(10), the humerus 3% -5%, and the lower arm 5% (11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Epidemiologymentioning

confidence: 99%

Non-Union Current Treatment Concept

2016

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Context: This article wants to give a current concept for the challenging decision for conservative or operative treatment strategies of nonunions according to the principles of 'diamond concept' and aspects that have to be attended. Evidence Acquisition: Between February 2010 and March 2014, 424 patients with non-unions were treated at Heidelberg university hospital. This database has been analyzed at least one year after the treatment. The analysis and the experience in surgery and treatment of non-unions as well as present literature were prepared for this review as a current concept. Results: If an atrophic non-union is suggested, reosteosynthesis and biological stimulation is required. A revision surgery of autologous transplantation of cancellous bone from the iliac crest is often enough. Alternatively, reamer-irrigator-aspirator (RIA) can be taken out of the femur with lower complications and pain in the extraction area and be combined with growth factors like bone morphogenetic proteins (BMPs), if consolidation after cancellous bone is still absent. In complex cases, consequential and radical removal of the infection often improved circulation through interventional angiography and use of the two-step procedure (the Masquelet technique) as well as a tissue covering are required. Conclusions: By using the 'diamond concept' as a complex concept, non-unions can be treated in different stages in a targeted manner.

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“…Shoulder pain and healing problems are complications reported. [2][3][4][5][6] The objective of this investigation was to evaluate the clinical outcome with the use of an antegrade interlocking intramedullary nail for the humeral fractures.…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of antegrade interlocking intramedullary nailing for humeral shaft fractures

et al. 2017

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INTRODUCTIONThe humeral shaft cylindrical in shape, the expanse between the proximal insertion of the pectoralis major and the distal metaphyseal flare of the humerus, adds resistance to both torsional and bending forces and provides strength. Adequate soft tissue envelope favors good prognosis in healing of uncomplicated fractures.Humeral shaft fractures account for approximately 1-3% of all fractures and 20% of humeral fractures with a bimodal distribution with peaks in young male patients, 21-30 years of age, and a larger peak in older females from 60-80 years of age.1 Most humeral diaphysis fractures are simple patterns of the mid-diaphysis These fractures have potential to cause significant disability in the young which is often temporary and in the old often permanent disability.Plating or intramedullary nailing are the main surgical options available for the definitive primary management of closed humeral shaft fractures and have their respective proponents with no consensus. ABSTRACT Background: Humeral shaft fractures which account for approximately 1-3% of all fractures and 20% of humeral fractures have potential to cause significant disability in the young which is often temporary and in the old often permanent disability. The use of locked intramedullary nailing for the treatment of humeral shaft fractures is gaining popularity because of its biomechanical and biological advantages. Methods: We present a descriptive retrospective review of 20 consecutive patients with acute humeral shaft fractures treated using an antegrade interlocking nail. Fracture union, functional outcome measured with Constant-Murley shoulder score and American shoulder and elbow surgeons (ASES) shoulder score and complications were assessed. Results: Patient age ranged from 20 to 74 years (average, 36 years) and average follow-up was 30.7 months (range, 12-48 months). There were 13 male patients and 7 female patients. Fracture of the middle third was most common accounting to 80% (16/20) of the fractures. Fracture union was achieved in 90% (18/20) of our cases. 2 patients had nonunion for which secondary surgeries were needed. According to Constant-Murley score, shoulder function was excellent in 70% (14/20) and good in 25% (5/20). Average ASES score was 93.3%. None of the patients had radial nerve palsy postoperatively. Conclusions: Gentle progressive reaming, correct entry point, minimal damage to rotator cuff, properly embedding the tip of the nail, good apposition of fracture fragments, static locking will help make antegrade intramedullary nailing, a dependable solution for the treatment of humeral shaft fractures and in achieving successful union with preserved/good shoulder and elbow function.

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Humeral nailing revisited

Cited by 118 publications

References 39 publications

Humeral shaft fractures

Humeral shaft fractures

Non-Union Current Treatment Concept

Functional outcome of antegrade interlocking intramedullary nailing for humeral shaft fractures

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