A comprehensive update on current fixation options for two-part proximal humerus fractures

Yoon, Richard S.; Dziadosz, Daniel; Porter, David A.; Frank, M; Smith, Wade R.; Liporace, Frank A.

doi:10.1016/j.injury.2013.08.024

Cited by 31 publications

(17 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…25 A biomechanical study of two-part fractures treated with IM nailing versus locking plates demonstrated higher failure rates in torsion with IM nailing than with locking plates, which suggests that early motion and osteoporotic bone could predispose to poor results. 37 Yoon et al 38 examined stiffness and load to fail-ure in a study of various fixation options for two-part proximal humeral fractures and found that IM nailing with a fixed angle blade was superior to IM nailing with locking screws, a 3.5-mm fixed angle plate, and a 4.5-mm fixed angle plate.…”

Section: Intramedullary Nail Fixationmentioning

confidence: 99%

Management of Acute Proximal Humeral Fractures

Kancherla

Singh²,

Anakwenze³

2017

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. A myriad of nonsurgical and surgical treatment options exist for these injuries, including short-term immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. The choice of treatment depends on the fracture type and severity, surgeon expertise, patient age, and patient health status.

show abstract

Section: Intramedullary Nail Fixationmentioning

confidence: 99%

Management of Acute Proximal Humeral Fractures

Kancherla

Singh²,

Anakwenze³

2017

J Am Acad Orthop Surg

View full text Add to dashboard Cite

show abstract

“…57 Biomechanical studies have also demonstrated the superiority of IM nailing over plating for 2-part surgical neck fractures. 7,15,17,24,54,55,58 Nevertheless, locking plate fixation of displaced surgical neck fractures is still favored by most surgeons.…”

mentioning

confidence: 99%

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

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

“…Its advantages include a reduced risk of bleeding due to a minimal skin incision, a relatively lower possibility of avascular necrosis (AVN), higher varus and valgus rotation resistance, and faster functional recovery of the shoulder joint after surgery. [10][11][12][13][14] Intramedullary fixation has the disadvantage that fixation strength of the humerus and bone fixation is relatively weak. However, the proximal humeral nail, especially the non-locking Polarus nail (Acumed, Beaverton, OR, USA), is capable of inserting cancellous screws in various directions in the humeral head.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiologic Results Comparing the Periarticular Proximal Humerus Locking Plate and Polarus Nail for Displaced Proximal Humerus Fractures

Min

Lee

Gwak³

et al. 2017

Clin Shoulder Elbow

View full text Add to dashboard Cite

BACKGROUND: This study compared the clinical and radiological outcomes of the single calcar screw plate and Polarus nail techniques for the treatment of the proximal humerus fractures.METHODS: Seventy-two patients diagnosed with displaced proximal humerus fracture were enrolled for the study. Of these, 50 patients underwent the locking plate surgery with a single calcar screw (plate group), whereas 22 patients underwent the Polarus nail surgery (nail group). The plate group was further divided into plate 1 group (with medial support), and plate 2 group (without medial support). The radiological and functional results of both groups were compared to the nail group.RESULTS: The α angle 1 year after surgery was significantly different between plate 1 and plate 2, and plate 2 and nail groups (p=0.041, p=0.043, respectively). The ratio that does not satisfy the reference value of γ angle was 2.8% in plate 1, 7.1% in plate 2 and 22.7% in nail group (p=0.007); there was a significant difference between plate 1 and nail group, and plate 2 and nail group (p=0.014, p=0.033, respectively).CONCLUSIONS: No significant differences were observed in the clinical results between locking plate and Polarus nail. However, in the plate 2 group and nail group, the rate of failure to maintain reduction during the 1-year period after surgery was statistically and significantly higher than the plate 1 group (level of evidence: level IV, case series, treatment study).

show abstract

A comprehensive update on current fixation options for two-part proximal humerus fractures

Cited by 31 publications

References 34 publications

Management of Acute Proximal Humeral Fractures

Management of Acute Proximal Humeral Fractures

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

Clinical and Radiologic Results Comparing the Periarticular Proximal Humerus Locking Plate and Polarus Nail for Displaced Proximal Humerus Fractures

Contact Info

Product

Resources

About