Intramedullary nailing of the proximal humerus: evolution, technique, and results

Dilisio, Matthew F.; Nowinski, Robert J.; Hatzidakis, Armodios M.; Fehringer, Edward V.

doi:10.1016/j.jse.2015.11.016

Cited by 82 publications

(71 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another major disadvantage of the first generation of humeral nails was inadequate security of the proximal screws leading to hardware problems, loss of reduction, and the need for unexpected reoperations. 14 Our results show that, even in elderly patients with osteoporosis and suboptimal bone density, locking technology applied to the humeral nail is reliable, providing strong capture of the proximal screws and avoiding hardware problems (Fig. 9).…”

Section: Discussionmentioning

confidence: 58%

“…46 The entry point of a straight nail must be located approximately 10 mm posterior and medial to the bicipital groove. 14,26,29,38,42 Once the proper entry portal was defined, a cannulated bone awl was used for entry and to reduce the humeral head under fluoroscopic guidance. A guidewire was placed through the bone awl into the humeral head.…”

Section: Percutaneous Im Nailing Of 2-part Surgical Neck Fracturesmentioning

confidence: 99%

“…1,39,44,48,50 The absence of secured mechanical locking for the proximal screws with the first generation of humeral IMNs has been a cause of screw migration with loss of reduction, as well as malunion. 13,14,33,39,43 Moreover, excessive nail diameter and length could lead to distal nail interlocking inside the humeral canal with distraction of the fracture site and surgical neck nonunion.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

Boileau

D’ollonne

Bessière³

et al. 2019

Journal of Shoulder and Elbow Surgery

Self Cite

View full text Add to dashboard Cite

Background: The high rates of complications and reoperations observed with the early designs of firstgeneration (unlocked) and second-generation (bent design) humeral intramedullary nail (IMNs) have discouraged their use by most surgeons. The purpose of this study was to report the results of a thirdgeneration (straight, locking, low-profile, tuberosity-based fixation) IMN, inserted through a percutaneous approach, for the treatment of displaced 2-part surgical neck fractures. Methods: We performed a retrospective review of 41 patients who underwent placement of a thirdgeneration IMN to treat a displaced 2-part surgical neck fracture (AO/OTA type 11A3). The mean age at surgery was 57 years (range, 17-84 years). After percutaneous insertion through the humeral head, the IMN was used as a reduction tool. Static locking fixation was achieved after axial fracture compression ("back-slap" hammering technique). Patients were reviewed and underwent radiography with a minimum of 1 year of follow-up; the mean follow-up period was 26 months (range, 12-53 months). Results: Preoperatively, 3 types of surgical neck fractures were observed: with valgus head deformity (Type A = 8 cases), shaft translation without head deformity (Type B = 19 cases), or with varus head deformity (Type C = 14 cases). At final follow-up, all fractures went on to union, and the mean humeral neck-shaft angle was 132°± 5°. We observed 2 malunions and 1 case of partial humeral head avascular necrosis. No cases underwent screw migration or intra-articular penetration. At last review, mean active forward elevation was 146°(range, 90°-180°) and mean external rotation was 50°(range, 20°-80°). The mean Constant-Murley score and Subjective Shoulder Value were 71 (range, 43-95) and 80% (range, 50%-100%), respectively. Conclusions: Antegrade insertion of a third-generation IMN through a percutaneous approach provides a high rate of fracture healing, excellent clinical outcome scores, and a low rate of complications. No morbidity related to the passage of the nail through the supraspinatus muscle and the cartilage was observed. The proposed A, B, and C classification allows choosing the optimal entry point for intramedullary nailing. The study was approved by the Institutional Review Board of Institut Universitaire Locomoteur et du Sport (No. 2016-02).

show abstract

Section: Discussionmentioning

confidence: 58%

Section: Percutaneous Im Nailing Of 2-part Surgical Neck Fracturesmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

Boileau

D’ollonne

Bessière³

et al. 2019

Journal of Shoulder and Elbow Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Vorteilhaft ist sicherlich die minimalinvasive Vorgehensweise bei der Implantation. Jedoch besteht durch den obligaten Zugang durch den M. supraspinatus oder dessen Sehne eine nicht unerhebliche Zugangsmorbidität [31,32]. Nachteilig erscheint weiterhin die eingeschränkte Möglichkeit der Reposition und Stabilisierung der Tuberkula [33].…”

Section: Marknagelunclassified

“…So ist das Ziel der operativen Intervention die übungsstabile Osteosynthese. Weitere Voraussetzungen für eine erfolgreiche Behandlung sind die anatomische Reposition und die gewebe-/durchblutungschonende Präparation [18,31].…”

Section: Schlussfolgerungen Und Empfehlungenunclassified

Standards in der Unfallchirurgie

Auerswald

Neumann

Breer

et al. 2016

Trauma Berufskrankh

View full text Add to dashboard Cite

Standards in der Unfallchirurgie Therapie der proximalen Humerusfraktur Die proximale Humerusfraktur ist immer noch eine Herausforderung für den Behandelnden. Neben der anspruchsvollen Diagnostik erschweren uneinheitliche Einteilungen und nicht validierte Therapieempfehlungen die Festlegung der jeweiligen Behandlung. Dabei ist zu erwarten, dass die Inzidenz aufgrund des demografischen Wandels eine steigende Tendenz haben wird. Epidemiologie Der Anteil an der Gesamtzahl jährlicher Frakturen beträgt 4-5 % [1]. Betroffen sind überwiegend Patienten in der zweiten Lebenshälfte, wobei die Inzidenz ab dem 40. Lebensjahr [2] eine deutliche Zunahme aufweist. Das Geschlechterverhältnis innerhalb der Patientengruppe änderte sich zwar zwischen 1970 und 2012 von etwa 3,6/1 [3] auf bis zu 2,3/1 [2], jedoch besteht weiterhin ein Überhang der weiblichen Betroffenen.

show abstract