Flexible intramedullary pins in the treatment of unstable proximal humeral fractures

Zifko, B; Poigenfürst, J; Pezzei, Ch.; Stockley, I

doi:10.1016/0020-1383(91)90167-d

Cited by 22 publications

(9 citation statements)

References 3 publications

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“…Our investigations do not allow for any statement about the anchoring of the wires in the bone alone. Considering the problem of wire loosening in the proximal humerus, for instance, the long lever arm at the drill hole and the torque caused by the mechanical set up should be taken into account [24]-this study did not focus on these influences. Anchorage of the conventional K-wire is given entirely by friction between wire and bone; among other factors, this is dependent on the surface condition of the wire.…”

Section: Discussionmentioning

confidence: 99%

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Do K-wires made from shape memory alloys increase pull-out forces? A preliminary experimental cadaver study in bovine bone

et al. 2007

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After osteosynthesis of the proximal humerus by Kirschner wires (K-wire), loosening and secondary loss can occur. This study tested primary fixation of wires made from a shape memory alloy (SMA) Nitinol (NiTi), compared to conventional steel K-wires by pull-out tests. Blocks of cancellous bone were tested with three wire types: NiTi-K-wire with split apex geometry and conventional steel K-wires with and without threads. We found that NiTi-wires can be pulled out of bone more easily than steel wires (P=0.05), even though the former had rougher surfaces. The application of NiTi-wires through bone produced no better stability in comparison to normal steel K-wires, because of triggering the memory effect. Further studies are required to determine if NiTi wires of another appropriate design, surface and localization are superior to conventional wires in the context of this application.

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Section: Discussionmentioning

confidence: 99%

“…Further advantages of NiTi alloys are high corrosion resistance and biocompatibility [23,24]. Like in orthodontics [1], angioplasty [10], and medical engineering [19], the advantages of devices made from memory alloys have been furthermore established in orthopaedics [5].…”

Section: Introductionmentioning

confidence: 99%

Do K-wires made from shape memory alloys increase pull-out forces? A preliminary experimental cadaver study in bovine bone

et al. 2007

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“…PHILOS is an angular stable implant for fixation of complex proximal humeral fractures. 1,2,3 Precontoured locking plates work on the principle of angular stability, less disruption of vascularity and less chances of plate failure. 4 Improved fixation by locking plates was attributed to the angular stability of the screws locking in the plate and their threedimensional distribution in the humeral head.…”

Section: How To Cite This Articlementioning

confidence: 99%

A Study on Proximal Humeral Fractures Stabilised With Philos Plate

K¹,

B²,

J³

2017

jebmh

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BACKGROUND Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, plant tan humerus fixator plates, Polaris nails and blade plates. Complications of these techniques include cutout or back out of the screws and plates, avascular necrosis, nonunion, malunion, nail migration, rotator cuff impairment and impingement syndromes. Insufficient anchorage from conventional implants may lead to early loosening and failure, especially in osteoporotic bones. In general, nonoperative treatment of displaced three and four-part fractures of the proximal humerus leads to poor outcome due to intraarticular nature of injury and inherent instability of the fragments. Comminuted fractures of the proximal humerus are at risk of fixation failure, screw loosening and fracture displacement. Open reduction and internal fixation with conventional plate and screws has been associated with unacceptably high incidence of screw pull out. PHILOS (the proximal humeral internal locking system) plate is an internal fixation system that enables angled stabilisation with multiple interlocking screws for fractures of the proximal humerus. MATERIALS AND METHODS 30 patients with proximal humerus fractures who were admitted in the Department of Orthopaedics, Government General Hospital, Kakinada, during the period November 2014-November 2016 were taken up for study according to inclusion criteria. All patients were treated with PHILOS plate. These proximal humerus fractures were classified according to Neer's classification. Patients were followed up at 6 weeks, 12 weeks and 6 months' interval. Functional outcomes for pain, range of motion and muscle power and function were assessed using the Constant-Murley scoring system. Collected data analysed with independent t-test and ANNOVA test. RESULTS The outcome of the study was 1 case (3.33%) had excellent result, 12 cases (40%) had good results, 12 cases (40%) had moderate results and 5 cases (16.66%) had poor results. Collected data analysed with independent t-test and ANNOVA test. In our study, T-test value was 8.529. Probability (P value) was <0.001, which was significant.

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“…Surgical techniques, recommended for the treatment of these sometimes demanding fractures ranges from percutaneous K-wires [14,15], to open cerclage wiring, flexible nails [16] to 4.5 mm T-and L-plates [17] and some very specialised methods like the 'Humeral Head Block' [18,19]. In heavily comminuted fractures, i.e., especially in all four-part fractures the recommendation was to directly replace the fractured humeral head by primary arthroplasty [20][21][22][23].…”

Section: Operative Treatmentmentioning

confidence: 99%

Proximal Humeral Fractures: Nailing

Rueger

Rücker

Briem

et al. 2007

Eur J Trauma Emerg Surg

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Treating proximal humeral fractures surgically has always been a challenge for the orthopaedic trauma surgeon. The challenge was and is due to numerous factors such as the specific anatomy of the proximal humerus, problems of an adequate approach and exposure of the fracture and different fracture fragments, possible iatrogenic injuries to the rotator cuff on approach and the detrimental effects of the former on the latter's gliding and contracting ability after surgery. Furthermore, the very different fracture patterns that can occur at the proximal humerus, the shear number of fragments which can be of extremely bad bone quality, the necessity for anatomic reduction of these fragments with an implant that will allow for a stable osteosynthesis and at the meantime will not impinge in the subacromial area and lastly, the intention of the physician-in-charge to commence with physical therapy as soon as possible post OP. All of these added to the fact that not one fixation technique with one certain implant could be recommended as a treatment or implant of choice in dealing with these difficult fractures. Most of the supposedly applicable surgical techniques and implants had major setbacks such as being limited to only very expert hands, necessitating a long-standing postoperative immobilisation, resulting in secondary loosening of implants, secondary loosening of reduction or impaired bone healing and, despite all efforts, finally led to poor function at the shoulder. With the advent of angular stable implants such as angular stable, anatomically contoured plates designed for proximal humeral fractures only and special angular stable nails for the same or similar indications the treatment options and the quality of treatment in this area was much improved. Our experience with angular stable nails of two different manufacturers in now more than 320 implantations reveals that indications for the surgical treatment of such fractures can be extended constantly, that the number of complications will simultaneously decline, the necessity for primary joint arthroplasty even in multiple fragment fractures is minimal and that long-term results are, comparing the published results in the literature with those of our institution, equal if not superior to other treatment options.

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Flexible intramedullary pins in the treatment of unstable proximal humeral fractures

Cited by 22 publications

References 3 publications

Do K-wires made from shape memory alloys increase pull-out forces? A preliminary experimental cadaver study in bovine bone

Do K-wires made from shape memory alloys increase pull-out forces? A preliminary experimental cadaver study in bovine bone

A Study on Proximal Humeral Fractures Stabilised With Philos Plate

Proximal Humeral Fractures: Nailing

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