Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails

Lópiz, Yaiza; García-Coiradas, J.; García-Fernández, Carlos; Marco, Fernando

doi:10.1016/j.jse.2013.08.023

Cited by 91 publications

(79 citation statements)

References 23 publications

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Section: Discussionmentioning

confidence: 69%

“…Complications related to rotator cuff disease were found to be significantly lower after straight nailing (34.6% versus 73%) [4]. Furthermore, the study demonstrated a significantly lower reoperation rate in the straight nail group (11.5% versus 42%) [4]. In another clinical study, Hessmann et al [20] found a mean Constant Score of 66.1 points after a mean follow-up time of six months in 17 patients with a mean age of 67.2 years.…”

Section: Discussionmentioning

confidence: 85%

“…In up to 25% of cases, post-operative loss of reduction and varus failure have been frequently described as two of the most common failure modes associated with surgical stabilization [1][2][3]. As an alternative surgical option to lateral locking-plate fixation, straight antegrade humeral nailing (SAN) has been introduced, providing promising results clinically [1,4]. Biomechanically, the lever arm of an intramedullary device is lower compared with a lateral locking plate, potentially counteracting varus displacing forces superiorly.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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Purpose Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this Bproximal anchoring point^(PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Methods Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Results Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20°abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). Conclusions The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the Bproximal anchoring point's^rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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“…The incidence of non union in proximal humeral fractures is about 1.1%, although it may increase to 8% in cases with metaphyseal comminution, and to 10% if the surgical neck is involved (1,11). Many clinical studies based on the reduction of 3 and 4 part proximal humeral fractures using plate and nails show cases of non union, even though they are numerically lower than infections (12)(13)(14). Non union is a mechanical problem affected by internal fixation, and is also influenced biological factors and comorbidity (1).…”

Section: Discussionmentioning

confidence: 99%

“…Matassi et al (15) reported the evaluation of clinical and radiographic outcomes of the plate and locking screws with intramedullary graft of allogeneic fibula in unstable humeral fractures in 17 patients (13). The outcomes revealed positive results in that no patients were lost during follow-up and there were no major complications.…”

confidence: 99%

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Rollo

Rotini

Pichierri

et al. 2017

ccmbm

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SummaryBackground. Fractures of the proximal part of the humerus represent almost 4-5% of all fractures. The rate of non union is estimated to be 1.1 to 10%. Non union, displacement, and fixation failure can be hazardous complications for these injuries. The purpose of our study was to evaluate the outcomes of plate and bone strut allograft with bone chips grafting augmentation in the management of proximal humeral aseptic non union. Methods. We treated 16 aseptic non union proximal humeral fractures by the medial humeral shaft bone strut allograft and lateral plate and screws with bone chips grafting. The patients' ages were between 55 and 70 years. The chosen criteria to evaluate the group during the clinical and radiological follow-up were the quality of life measured by The Short Form (12) Health Survey (SF-12), shoulder function and related quality of life measured by the Constant Shoulder Score (CSS) compared with healthy side, bone healing measured by X-rays, and postoperative complications. The follow-up was perfor med with clinical and radiographic controls at 1, 3, 6 and 12 months. Surgical time and international units of red blood cells transfused were also calculated. The evaluation endpoint was set at 12 months. Results. The X-rays bone healing occurred in our group on average of 126.4 days after surgery. The surgical time and blood loss were consistent with standard surgical procedures. The quality of life and functional recovery were excellent after plate and bone strut allograft. Conclusions. Surgical techniques that increase mecha nical stability, while incorporating bone biology, are effective aids for treating problematic fractural patterns.KEY WORDS: aseptic non union; proximal humeral fracture outcome; bone strut allograft; plate; osteosynthesis; complications.

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Interventions for treating proximal humeral fractures in adults

Handoll

Brorson

2015

Cochrane Database of Systematic Reviews

247

111

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Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails

Cited by 91 publications

References 23 publications

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Interventions for treating proximal humeral fractures in adults

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