New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients

Mihara, Kenichi; Tsutsui, Hiroaki; Suzuki, Koji; Makiuchi, Daisuke; Nishinaka, Naoya; Yamaguchi, Ken

doi:10.1007/s00776-007-1193-3

Cited by 22 publications

(10 citation statements)

References 19 publications

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“…Other authors have described an extra-articular, extra-rotator cuff entry point located more lateral to the greater tuberosity using an angulated nail that preserves the articular surface and rotator cuff integrity. 10) Nonetheless, each of these techniques has its unique advantages and disadvantages, and therefore, the most appropriate technique should be selected after considering factors known to influence functional outcomes, such as, patient characteristics, bone quality, fracture type, and surgeon's experience.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point

Shon

Bang²,

Yoo

2015

Clinics in Shoulder and Elbow

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Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores. Antegrade intramedullary nailing (AIN) has been recently recognized as a valid option and a reliable alternative to locking plate fixation for humeral fractures, and is more in accord with the principles of minimal invasive surgery. 1) In fact, AIN has several advantages, that is, better rotational stability, a good lever arm effect, less soft tissue damage at the fracture site, shorter operative time, lower infection rates, and earlier functional recovery. However, it is also associated with persistent shoulder pain and an unsatisfactory outcome rate of 20% to 40%, in some cases shoulder function does not return to normal even after nail removal. 1) Complications associated with poor shoulder function after antegrade intramedullary nail insertion in the humerus include, rotator cuff damage near the point of insertion, impingement or superior protrusion of the nail in the subacromial space, nail loosening, screw back-out, and joint stiffness. 1)Here, we present a case of a non-healed longitudinal tear of the supraspinatus tendon at the insertion point of an intramedullary humeral nail with severe secondary impingement, its clinical results after cuff repair, and subacromial decompression. The patient provided informed consent for the publication of his case information in the form of a case report. Case ReportA 29-year-old man presented complaining of a 4-year history of right shoulder pain and snapping, especially during forward elevation and abduction of the right shoulder. The patient sustained a mid-shaft fracture of the right humerus during a fall from a height of 8 m while working in July 2004. At that time, he was treated at a local hospital immediately, although

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Section: Discussionmentioning

confidence: 99%

Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point

Shon

Bang²,

Yoo

2015

Clinics in Shoulder and Elbow

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“…Several authors recommend surgery with an endomedullary nail as the treatment of choice in displaced fractures with two or three fragments according to Neer's classification, in that it is a good compromise between minimally invasive treatment and the insertion of a plate, reserved for younger patients. The literature contains reports of endomedullary nailing with proximal screw locking [1,2,5,7,8] or wires [4,6]. Proximal humerus nailing, used in our cases and mentioned in recent literature [9][10][11][12], has a proximal locking mechanism with a spiral blade.…”

Section: Introductionmentioning

confidence: 93%

“…Instable, non-reducible fractures of the surgical neck of the humerus often occur in advanced age [1][2][3] and are prevalent in women [2,4]. Several authors recommend surgery with an endomedullary nail as the treatment of choice in displaced fractures with two or three fragments according to Neer's classification, in that it is a good compromise between minimally invasive treatment and the insertion of a plate, reserved for younger patients.…”

Section: Introductionmentioning

confidence: 99%

PHN for treatment of proximal humerus fractures: evaluation of 80 cases

2009

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This paper analyses 80 cases of displaced proximal humerus fractures, with two or three fragments, treated by PHN nailing. The hold of the spiral blade was effective, and is particularly recommended for fractures with two fragments according to Neer's classification. The results, analysed with Constant's score and radiographic checkups, were satisfactory. Nearly all our patients (76 out of 80) had a mean age of 75 years and a total Constant score of 78.48. Only four (mean age 42.5 years) had a Constant score of 86. Shoulder articulation was good and only a few complications occurred.

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“…During the last 2 decades, numerous surgical approaches and fixation techniques have been proposed to treat displaced proximal humerus fractures including arthroplasty, 1,2 screw fixation, 3 suture fixation, 4 tension band wiring, 5 intramedullary nailing, 6 and various types of plates. 7-10 Most of these techniques have shown satisfactory postoperative results, [1][2][3][4][5][6][7][8][9][10] but the wide variety of implants suggests that the optimal method of fixation has yet to be established.…”

Section: Introductionmentioning

confidence: 99%

Closed Reduction and Minimally Invasive Percutaneous Fixation of Proximal Humerus Fractures Using the Humerusblock

Brunner¹,

Weller²,

Thormann³

et al. 2010

Journal of Orthopaedic Trauma

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The Humerusblock system allows reliable minimally invasive fixation of selected displaced proximal humerus fractures, even in elderly patients with potentially reduced bone mass. In this study, postoperative rates of avascular necrosis were lower than that which has been reported after conservative treatment and open anatomic reduction and internal fixation. The overall unplanned re-operation rate of 40% was high, comparable with what has been reported for conventional percutaneous pinning. However, clinical outcome was good in 77% of the patients, and reduction could be held in 91% successfully, including elderly patients with potentially reduced bone mass.

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New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients

Cited by 22 publications

References 19 publications

Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point

Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point

PHN for treatment of proximal humerus fractures: evaluation of 80 cases

Closed Reduction and Minimally Invasive Percutaneous Fixation of Proximal Humerus Fractures Using the Humerusblock

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