Intramedullary Nailing of Combined/Extended Fractures of the Humeral Head and Shaft

Garnavos, Christos; Lasanianos, Nikolaos

doi:10.1097/bot.0b013e3181b2b74d

Cited by 21 publications

(35 citation statements)

References 32 publications

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“…2,4,14,31 Open reduction and internal fixation (ORIF) of a plate and anterograde intramedullary nailing have become widely accepted methods of treatment. 3,10,11,15,18,32,37 However, ORIF is associated with extensive soft tissue dissection and bears the risk of iatrogenic injury to the radial nerve, 2,14,20 whereas anterograde intramedullary nailing has been associated with higher rates of intraoperative rotator cuff injuries which may lead to shoulder dysfunction in the postoperative follow-up. 10,11,37 In 2004 Livani et al 28 proposed a minimally invasive anterior approach to perform indirect reduction and percutaneous anterior plate fixation of humeral shaft fractures.…”

mentioning

confidence: 98%

Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS)

Brunner

Thormann

Babst

2012

Journal of Shoulder and Elbow Surgery

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mentioning

confidence: 98%

Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS)

Brunner

Thormann

Babst

2012

Journal of Shoulder and Elbow Surgery

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“…Finally, persistent shoulder pain was reported in over 40% of their cases, which is consistent with the known risk of iatrogenic injury to the rotator cuff when humeral nailing is performed. 22 Minimally invasive plate osteosynthesis is a viable technique for the geriatric population with proximal humeral fracture with shaft extension, and good results have been reported. 23 However, MIPO for this indication is very operator dependent.…”

Section: Discussionmentioning

confidence: 99%

Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus

James

Farrell

Evans

et al. 2014

Geriatr Orthop Surg Rehabil

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Purpose: A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications. Methods: From 2008 to 2012, 21 such operations were performed; 18 were considered ''fragility'' fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis. Open reduction and internal fixation (ORIF) was employed using direct reduction and fixation with a long periarticular locking plate. Physiotherapy was commenced 2 weeks postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess functional outcome at a time point greater than 1 year postoperative. Results: The study group consisted primarily of elderly females (83% with a median age of 69 years) whom sustained complex metadiaphyseal proximal humeral fractures after simple mechanical fall (78%). Uneventful union occurred in all cases. Local complications included 1 case of partial radial nerve palsy, which had resolved completely by 1 year. No cases of infection were identified. Long-term return to functionality was evident with a median DASH score of 12 (mean ¼ 21, standard deviation ¼ 20, n ¼ 13). Seventy five percent of patients reported minimal or no pain (question [Q] 24), and 75% achieved return of overhead function (Q6, 12, and 15). Conclusion: Treatment of complex metadiaphyseal fragility fractures with anatomic reduction, fixed angle plating, and early physiotherapy returns the older patient to optimized functionality with minimal risk of complication. The DASH outcomes are equivalent to ORIF of isolated proximal humerus fractures and clinically indistinguishable from the general population.

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“…This delay in bone union may induce angular and rotational deformity and limited postoperative shoulder movement. 12,13) For those unable to receive conservative treatment because of severely displaced fractures, comminuted fractures, co-sustained injuries that make early rehabilitation difficult, pathologic factures, and vascular damages, surgical interventions should be considered. 14,15) The main surgical interventions for humeral shaft fractures include plate fixation, intramedullary nailing, and external fixation; of these, the intramedullary nailing has received the most recognition for its efficacy in treating fractures of shaft of many long bones, such as the femoral and tibial bones.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures

Yang¹,

Kim

Kang

et al. 2015

Clinics in Shoulder and Elbow

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Background: Our aim was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on a Polarus intramedullary nail for the internal fixation of humeral shaft fractures. Methods: From January 2008 to March 2014, we enrolled 26 patients with humeral shaft fractures who were operated on using intramedullary nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the Polarus nail: in group 1, a single interlocking distal screw was used in 12 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. To compare the nonunion and shoulder function, we assessed each patient's modified American Shoulder and Elbow Surgerns (ASES) score. Results: We found that 10 of 12 fractures achieved union in group 1, and 13 of 14 fractures, in group 2. We did not find a meaningful difference in the time to bone union between the two groups. The percentage of recovery of displaced fracture fragments until union was 66.9% for group 1 and 59.41% for group 2. At the final follow-up, we found that the scores for shoulder joint modified ASES was 78.7 for group 1 and 80.7 for group 2. Conclusions: Our results show that if locked appropriately, even a single screw on a Polarus nail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.

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Intramedullary Nailing of Combined/Extended Fractures of the Humeral Head and Shaft

Abstract: Intramedullary nailing for proximal humeral fractures associated with shaft extension or segmental involvement appears to offer a reliable treatment option.

Cited by 21 publications

References 32 publications

Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS)

Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS)

Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus

Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures

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