MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

Bu, Guoyun; Sun, Weitang; Li, Jianan; Yang, Tao; Li, Mingxin; Wei, Wanfu

doi:10.1177/21514593211043961

Cited by 7 publications

(9 citation statements)

References 38 publications

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“…However, the varus group showed the largest NSA change of the three groups and, the NSA change in the plate group was significantly larger than in the medullary nail group, especially among the varus cases. This is similar to the findings of Bu et al 21 . which reflects the biomechanical advantage of the nail in resisting varus and rotational stresses.…”

Section: Discussionsupporting

confidence: 92%

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Dai

Xiang

Zhang

et al. 2023

Orthopaedic Surgery

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ObjectiveThere is currently no consensus on proximal humerus fractures with an initial deformity in the coronal plane who are better off with plates or nails, so we designed this study. To compare the effect of the initial deformity in the coronal plane of proximal humerus fractures on postoperative outcomes, we compare the maintenance of reduction in procedures utilizing plates and nails, and analyzed the subsequent occurrence of complications to explore whether the initial deformity should dictate the fixation approach.MethodsThe clinical data of patients with proximal humerus fractures who were hospitalized and underwent surgical treatment in our hospital from January 2016 to December 2020 were reviewed. Postoperative functional scores (American Shoulder and Elbow Surgeons, ASES; Constant‐Murley Score, CMS), Neck‐shaft angle (NSA), Quality of fracture reduction, Deltoid Tuberosity Index (DTI), and complications were compared among cases with initial varus, normal, or valgus deformities.ResultsWe included 131 patients, 56 males and 75 females, with a mean age of 60.89 ± 5.53 years (range 50–76) and a mean follow‐up duration of 16.63 ± 6.78 months (range 12–48). Of these, 29 cases had initial varus displacement, 71 had a normal NSA, and 31 had initial valgus displacement. Seventy‐five were treated with a locking plate and 56 with a nail. After open reduction and internal fixation, the NSA was restored to normal (−135°) in all patients in all groups (P > 0.05). There was a significant difference in NSA changes at the last follow‐up; 2.93° ± 2.12° in the varus group, 1.77° ± 1.18° in the normal group, and 2.32° ± 1.64° in the valgus group, with the highest change occurring in the varus group. There was no significant difference in the range of motion or functional scores including ASES and CMS among the three groups (P > 0.05). The complication rate of 20.7% in the varus group was significantly higher than the complication rates of 12.7% in the normal and 12.9% in the valgus groups (P < 0.05).ConclusionsWhile proximal humerus fractures with initial coronal displacement (varus, normal, and valgus) show similar postoperative functional outcomes, varus fractures have a higher rate of complications. The nail provides better maintenance of reduction than the locking plate, especially in varus fractures.

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Section: Discussionsupporting

confidence: 92%

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Dai

Xiang

Zhang

et al. 2023

Orthopaedic Surgery

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“…The straight intramedullary MultiLoc nail (Depuy Synthes) is a known third-generation intramedullary nail. Multiloc changed the design of the proximal 4–6° valgus angle of the second-generation intramedullary nail to that of a proximal straight nail [ 11 , 14 ]. The straight design theoretically leaves a safe zone between the lateral fracture fragment and the nail entry hole in the humeral head to avoid an unpredictable crack in this area (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The Multiloc intramedullary nail adds to the calcar screw design to provide better support for patients with large proximal medial cortical defects [ 19 ]. Several previous studies demonstrated the biomechanical advantages of the intramedullary nail [ 14 – 16 , 20 ]. There is a high risk of secondary displacement and fracture nonunion in elderly patients with poor bone quality.…”

Section: Discussionmentioning

confidence: 99%

“…During the fixation of PHFs with interlocking intramedullary nails, Kirschner wires are often used to hold the bone fragments in a limited incision for closed reduction [14][15][16]. Herein, the minimally invasive procedure used in the intramedullary nail group resulted in reduced intraoperative blood loss compared to the larger incision size utilized in the locking plate group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures

et al. 2022

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Background The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance. Methods Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant. Results A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up. Conclusion Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.

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“…1,4 While most PHFs are minimally displaced or nondisplaced, for which conservative management is usually recommended, 1,5 controversy exists regarding optimal management of displaced and comminuted PHF. 6,7 There are a number of fixation techniques, such as tension-band routing, locking plate fixation, and intramedullary nailing over the past decade [8][9][10][11][12][13][14] ; however, no single technique demonstrated evidence-based superiority. Although locking plate fixation is considered as the standard treatment, complication rates are still unsatisfactory.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar

2022

Orthopaedic Surgery

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ObjectiveRestoration of the medial support is especially important for the treatment of proximal humeral fractures. The objective of this study was to investigate the radiographic and clinical outcomes of intramedullary nail fixation with a special focus on the presence of calcar comminution.MethodsIn this retrospective study of patients with displaced proximal humeral fractures that were treated by intramedullary nail between January 2018 and July 2021, fracture morphology and the calcar integrity were noted on preoperative radiographs. Patients were divided into two groups according to calcar integrity. During follow‐up, radiological assessment and functional outcome, including the deltoid tuberosity index (DTI), neck shaft angle (NSA), visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, active and passive range of motion, were performed. A Student t‐test and univariate logistic regression analysis was used.ResultsA total of 83 patients (54 female, 29 male) had complete follow‐up (average, 12.8 months; range, 10 to 33 months) and functional assessment in our study. The average age was 58.6 years (range, 20 to 89 years). The mean loss of NSA was 4° (range, 0°–12°) and no significant difference was found between two groups (p = 0.27). DTI had an average of 1.50 ± 0.19 (range 1.13–2.04). Patients with intact calcar achieved greater range of forward elevation (129.06 ± 11.91 vs. 121.05 ± 11.97, p = 0.01), and higher SST scores (8.61 ± 1.85 vs. 7.37 ± 2.22, p = 0.02). Two groups showed similar outcomes in VAS, ASES score, and range of abduction. One patient demonstrated a proximal interlocking screw cutting through and osteonecrosis of the humeral head, who underwent a second surgery for screw removal. There were no cases of infection, malunion, nonunion, nerve injury, subacromial impingement, or rotator cuff tear during the study period.ConclusionIntramedullary nail can favorably be used to manage proximal humeral fractures with good early radiographic and functional outcomes, even for those with comminuted calcar.

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MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

Cited by 7 publications

References 38 publications

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures

Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar

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