Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series

Metsemakers, Willem‐Jan; Wijnen, V.; Sermon, An; Vanderschot, Paul; Nijs, Stefaan

doi:10.1007/s00402-015-2296-5

Cited by 8 publications

(9 citation statements)

References 37 publications

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“…Similar case studies have been reported. Metsemarkers reported 5 patients (4%) who had early technical failures that required revision surgery [5]. In one case, the patient incurred an iatrogenic fracture during retrograde nailing.…”

Section: Discussionmentioning

confidence: 99%

“…The major disadvantages of external fixators are the length of operation time required, pin-tract infections, and the large size of the frame, resulting in significant discomfort for the patient. Intramedullary nailing, which has been used by many surgeons in the treatment of humeral nonunions [4,5], is an accepted technique for the treatment of humeral diaphyseal nonunion, and is also an established method for the treatment of highenergy long bone fractures, especially in a polytrauma setting and in osteoporotic, impending and pathological fractures. The technical errors and complications after intramedullary nailing of humeral diaphyseal nonunion have been recorded and discussed in only a limited number of studies [5].…”

Section: Introductionmentioning

confidence: 99%

“…Intramedullary nailing, which has been used by many surgeons in the treatment of humeral nonunions [4,5], is an accepted technique for the treatment of humeral diaphyseal nonunion, and is also an established method for the treatment of highenergy long bone fractures, especially in a polytrauma setting and in osteoporotic, impending and pathological fractures. The technical errors and complications after intramedullary nailing of humeral diaphyseal nonunion have been recorded and discussed in only a limited number of studies [5]. Therefore we present our experience with extreme complications in the treatment of humeral diaphyseal nonunion of the long bones with the application of intramedullary nailing.…”

Section: Introductionmentioning

confidence: 99%

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Troubleshooting in the Treatment of Pseudoarthrosis After a Humeral Diaphyseal Fracture: A Case Report

Kurinomaru

Zenke

Furukawa

et al. 2016

J UOEH

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: We report a case of a patient with a history of surgery for insufficient pseudoarthrosis after a humeral diaphyseal fracture. Although most humeral nonunions are successfully treated with a single procedure, some humeral nonunions are more difficult to heal and require multiple procedures. A-61-year-old man presented at our hospital with pain and deformity in his left upper arm. The humeral diaphyseal fracture had been previously treated elsewhere with open reduction and internal fixation. Some days prior to his visit at our hospital, he had had pain in his left upper arm, without a particular cause, and was admitted to our hospital for initial evaluation. After a complete physical examination, symptoms of infection and any neurovascular deficit were ruled out. Radiographic examination revealed atrophic nonunion of the middle third of the humeral shaft associated with disuse osteopenia. Anterograde intramedullary nailing and bone grafting were performed for the resistant atrophic nonunion of the humeral diaphysis. In addition to the intramedullary nailing, additional fixation was performed for residual rotational instability. A postoperative evaluation revealed a periprosthetic fracture in the distal part of the humerus. Poor bone quality or a deficient plate technique might have lead to the facture. We performed open reduction and internal fixation (ORIF): he underwent fixation with a 2-plate construct for the nonunion of the humeral diaphyseal fracture, together with decortication, debridement, and bone grafting. Eight months after surgery, the patient's bone had healed and he had recovered flexion (110°) and extension (−30°) without complications. An orthopedic surgeon should be aware of these complications when choosing open reduction and internal fixation for the treatment of a history of insufficient pseudoarthrosis. Patients should be closely followed up for evidence of any complications such as infections and malunions. Fracture fixation in patients with pseudoarthrosis requires strategies to overcome the technical difficulties faced during the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Troubleshooting in the Treatment of Pseudoarthrosis After a Humeral Diaphyseal Fracture: A Case Report

Kurinomaru

Zenke

Furukawa

et al. 2016

J UOEH

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“…Surgery is considered when this conservative treatment fails to maintain the stability of reduction, open fracture, or other combined injuries. Many surgical techniques have been introduced to correct humeral shaft fractures, and there have been debates regarding their clinical indications 2. One of the standard surgical treatments is closed reduction and internal fixation using antegrade intramedullary nails.…”

Section: Introductionmentioning

confidence: 99%

“…One of the standard surgical treatments is closed reduction and internal fixation using antegrade intramedullary nails. This technique has several potential advantages over other methods, including open reduction and internal fixation with plates, in terms of reduced disruption to the surrounding soft tissue and greater preservation of extramedullary vascularity around the fracture site 23. However, it can be difficult to perform a closed reduction or obtain the required stability from fixation with an intramedullary nail in highly unstable fractures of the humeral shaft in which there are complex or severely-displaced fragments, and such difficulties could result in delayed union or non-union of the bone fragments 4.…”

Section: Introductionmentioning

confidence: 99%

Do Cerclage Cables Delay the Time to Bone Union in Patients with an Unstable Humeral Shaft Fracture Treated with Intramedullary Nails?

2017

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PurposeTo evaluate the time to bone union after open reduction and internal fixation with cerclage cables followed by intramedullary nailing (IMN) for unstable humeral shaft fractures.Materials and MethodsPatients with a humeral shaft fracture treated by IMN were enrolled. One group of patients was treated via open reduction and internal fixation with cables followed by IMN (cable group; n=32), while the other group was treated with a conventional closed IMN (non-cable group; n=64). The length of time to bone union and functional scores [Disabilities of the Arm, Shoulder and Hand (DASH) and University of California, Los Angeles (UCLA) scores] were measured for all patients.ResultsNo significant differences were found in terms of age, gender, injury type, or smoking history between the two groups, except for the type of fracture. The cable group had significantly more complex types of fracture than the non-cable group (p<0.001). The mean time to bone union was 3.9 months in the cable group, while in the non-cable group, it was 4.4 months (p=0.041). The incidence of postoperative complications, such as non-union, delayed union, and radial nerve palsy, was similar between the two groups (p>0.05). No differences were identified in terms of DASH and UCLA scores (28.8 and 32.1 in the cable group and 26.4 and 32.6 in the non-cable group, respectively; p=0.335 and 0.264).ConclusionIn unstable humeral shaft fractures treated by IMN, open reduction and internal fixation with additional cerclage cables do not delay the length of time to bone union or increase the rate of other complications.

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Surgical Management of Humeral Shaft Fractures

Zublin

2024

Orthopaedics and Trauma

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Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series

Cited by 8 publications

References 37 publications

Troubleshooting in the Treatment of Pseudoarthrosis After a Humeral Diaphyseal Fracture: A Case Report

Troubleshooting in the Treatment of Pseudoarthrosis After a Humeral Diaphyseal Fracture: A Case Report

Do Cerclage Cables Delay the Time to Bone Union in Patients with an Unstable Humeral Shaft Fracture Treated with Intramedullary Nails?

Surgical Management of Humeral Shaft Fractures

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