Short, Locked Humeral Nailing via Neviaser Portal

Knierim, Annie; Bollinger, Alexander J.; Wirth, Michael A.; Fehringer, Edward V.

doi:10.1097/bot.0b013e31825194ad

Cited by 22 publications

(17 citation statements)

References 29 publications

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“…They noted that the use of fresh-frozen cadavers changes the pliability of the tissues and the ability to obtain a starting point. 14 In contrast to the study by Knierim et al, 14 in the current case the authors were able to easily place humeral nails through the Neviaser portal in a patient with cuff tear arthropathy. The shielding effect of the acromion was the authors' primary indication to use the extended Neviaser portal approach.…”

Section: A 4bcontrasting

confidence: 81%

“…The portal has been subsequently used to arthroscopically address rotator cuff, superior labrum, and distal clavicle pathology. [10][11][12][13] Knierim et al 14 first described the technique of using the Neviaser portal in antegrade humeral nailing in a cadaveric study. To the authors' knowledge, extending the traditional superomedial portal to the shoulder to perform humeral nailing has never been described clinically.…”

Section: Case Reportmentioning

confidence: 99%

“…7 Retrograde nailing of humeral shaft fractures has also been described but is complicated by elbow stiffness, increased risk of iatrogenic fracture, and neurologic injury. 18 In an effort to avoid the rotator cuff footprint during humeral nail insertion, Knierim et al 14 reported the Neviaser portal approach to antegrade humeral nailing in a cadaveric study. They noted that all nails passed entirely through supraspinatus muscle belly with no supraspinatus tendon or long head of the biceps tendon damage.…”

Section: A 4bmentioning

confidence: 99%

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Extended Neviaser Portal Approach to Antegrade Humeral Nailing

Dilisio¹,

Fitzgerald²,

Miller³

2013

Orthopedics

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Certain arthropathies can distort the normal acromiohumeral relationship and make traditional anterolateral access to the proximal humerus for nailing difficult or impossible. This article presents a case of bilateral antegrade humeral nailing in which the Neviaser portal approach was used for humeral shaft fractures in a patient with distorted shoulder anatomy secondary to severe cuff tear arthropathy and rheumatoid arthritis. Based on a literature review, extending the traditional superomedial (Neviaser) portal to the shoulder to perform humeral nailing has never been described clinically. An 85-year-old woman with rheumatoid arthritis and bilateral cuff tear arthropathy presented after a mechanical fall from standing height with bilateral acute humeral shaft fractures. Preoperative fluoroscopy confirmed the inability to access the traditional starting point with an anterolateral approach due to a shield acromion resulting from cuff tear arthropathy and rheumatoid arthritis. Bilateral locked antegrade humeral nails were successfully placed through a 3-cm incision just off the medial border of the acromion and directly posterior to the acromioclavicular joint (the extended Neviaser portal approach). Postoperatively, the patient demonstrated early evidence of clinical and radiographic union. She was able to return to her preinjury function level, with an active range of motion comparable with her baseline. The Neviaser portal approach to antegrade humeral nailing is an effective solution to diaphyseal humeral fractures when access to the traditional anterolateral proximal humeral starting port is not possible due to distorted shoulder anatomy.

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Section: A 4bcontrasting

confidence: 81%

Section: Case Reportmentioning

confidence: 99%

Section: A 4bmentioning

confidence: 99%

See 1 more Smart Citation

Extended Neviaser Portal Approach to Antegrade Humeral Nailing

Dilisio¹,

Fitzgerald²,

Miller³

2013

Orthopedics

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“…Furthermore, in a recent report by Hatzidakis et al, 6) patients managed by antegrade locking intramedullary nailing of surgical neck fracture of the humerus via an articular entry point demonstrated reliable fracture-healing, favorable clinical outcomes, and little residual shoulder pain. In addition, several approaches, such as, the rotator interval splitting approach, 7) approach via Neviaser ioportal, 8) and an all-arthroscopic technique, 9) have been developed that involve nail insertion through a more medial entry point to minimize postoperative shoulder pain and preserve the critical hypovascular region of the rotator cuff. However, these techniques result in a tradeoff at the cost of articular cartilage damage, and its long-term effects are unknown.…”

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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“…Thus, various techniques such as the Neviaser approach have been developed in previous reports to prevent cuff tears. 23,24 In the future, comparative studies on postoperative shoulder-related complaints after using a single implant are needed.…”

Section: F Group S Group C Group P Valuementioning

confidence: 99%