Humeral shaft fractures treated by interlocking nailing: a preliminary report on 16 patients

Jensen, Claus Hjorth; Hansen, Dick; Jørgensen, U. G.

doi:10.1016/s0020-1383(05)80005-1

Cited by 37 publications

(9 citation statements)

References 8 publications

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“…1,4,16,21,28,29 This approach is associated with a high incidence of compromised postoperative shoulder function 10 because it injures the rotator cuff in its critical hypovascular region, 30 which has poor healing potential. Other factors implicated for impaired shoulder function after antegrade nailing include the impingement phenomenon of the nail in the subacromial space, 11,19 superior protrusion of the nail, 17,18,21 and loosening of the proximal interlocking screw. 16,17,20,21 Ajmal et al 12 reported a series of 33 patients who underwent operation with the conventional approach with Their results are better than those from our series, but the technique has certain constraints because it is difficult to stabilize the associated proximal humerus fractures, whereas our technique has much wider applications ( Figure 4) and can be used to adequately stabilize complex fractures ( Figure 6).…”

Section: Discussionmentioning

confidence: 99%

“…12,15,16 The proposed etiology of postoperative shoulder pain is damage to the subacromial space and the rotator cuff, along with prominence of the hardware. 11,[16][17][18][19][20][21] This is a concern for both the surgeon and the patient because the pain is unrelenting in nature, takes a long time to resolve, and is an indication for implant removal after bony union. 22 In an endeavor to improve postoperative shoulder function and pain scores after AIN of humeral fractures, the surgical approach and entry point for the procedure was modified.…”

Section: Introductionmentioning

confidence: 99%

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Antegrade Humeral Nailing Through the Rotator Cuff Interval: A New Entry Portal

Park

Pandher

Chun

et al. 2008

Journal of Orthopaedic Trauma

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The conventional approach for antegrade intramedullary nailing (AIN) of humerus fractures is associated with persistent pain and compromised shoulder function. Damage to the critical hypovascular zone of the rotator cuff near its insertion on the humerus and/or irritation of the subacromial space by prominent hardware are the factors believed to be responsible for poor shoulder function after AIN of the humerus. This study describes a new entry portal through the rotator interval that minimizes iatrogenic damage to the rotator cuff at its insertion. This approach offers a solution for the disappointing postoperative shoulder function and pain scores associated with conventional antegrade nailing techniques. This study consisted of 33 patients with 34 humeral fractures followed for an average of 34 months. The overall satisfaction rate was more than 90%, according to the ASES (American Shoulder and Elbow Society) score. The mean Constant Score was 84 (SD, 14; range, 17 to 98), and primary bone union was achieved in 32 of the 34 cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antegrade Humeral Nailing Through the Rotator Cuff Interval: A New Entry Portal

Park

Pandher

Chun

et al. 2008

Journal of Orthopaedic Trauma

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“…Functional results were satisfactory to excellent according to the Neer score [31,39,52,56,66,68,69,98,116,117,125]. In other series however the SN was cause of fierce criticism: complications in more than 50 %, problems with the locking system occurred in more then 30 %, iatrogenic fractures in more then 20 % and non-union in up till 40 % of cases.…”

Section: Introductionmentioning

confidence: 85%

The Locking Nail for the Humerus - Does it Fulfill the Expectations?

Verbruggen¹

2008

Osteosynthesis and Trauma Care

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IntroductionThe humeral shaft fracture constitutes only 1 to 5 % of all human fractures [57,68,82]. Most of the time it concerns simple fracture patterns, type A or B according to the AO classification. In less then 18 % C-type fractures are found. Less then 6 % are open fractures [28,82,89,128]. In the above 50s, 80 % of humeral shaft fractures are caused by a simple fall [7]. Combined with the lower anatomical demands for the humerus, this makes it the ideal bone for non-operative treatment (Fig. 1). The Sarmiento brace allows early use of shoulder and elbow joint and can be considered the standard for treatment of humeral shaft fractures [37,61,67,71,77,92,110,112,137,138,142]. Despite good results, high failure rates up to 41 % have been reported after non-operative treatment as well [27,48]. Some circumstances therefore will request operative treatment of humeral shaft fractures. These include failure to maintain reposition, neurovascular lesion, floating elbow, (impending) pathologic fractures, open fractures, poly-trauma, non-union and uncooperative patients. The golden standard for operative treatment of the humerus has been the plate (Fig. 2) for a long time leading to high union rates [4, 8, 9,32,33,58,59,60,87,91,130,141] ( Table 1). The most important point of criticism has been the large incisions with soft tissue damage enhancing the risk for non-union and infection. For a long time the only alternative technique for the plate were the elastic nails like bundle nailing and rush pins. Minimal invasive techniques, indirect reposition of the fracture preserving the fracture haematoma and less soft tissue damage are the main advantages. Good healing results have been reported with non-union rates of 1.2 up till 6.8 % [21, 25, 27,34,35,38,47]. Disadvantages are the lesser rotational and axial stability of the constructs. Early functional treatment therefore is not always possible.An interlocking nail combines the minimal invasive technique with the rotational and axial stability of a plate. Seidel introduced the Humeral Locking Nail ® (SN) (Fig. 3). Good healing results with non-union rates of 0 up to 4 %. have been reported. AbstractThe purpose of this article is to evaluate the humeral locking nail in the treatment of humeral shaft fractures. First disappointing experiences with reamed locking nails led at least to some controversy. A review of the literature on treatment of humeral fractures showed that he majority of (clinical) information was contained in retrospective reviews; only three prospective or randomized studies were identified. Furthermore the results are not consistent. The criticism based on experiences with first implants is not entirely justified. The humeral locking nail is a valid implant for the treatment of humeral fractures. Like every other implant however it comes with its own specific complications and there is a learning curve. The humeral locking nail therefore should be seen as a complementary technique to the existing implants with its own advantages and drawbacks.

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“…Reported rates of fracture end union have been > 90% [5,13,14], 96 [15] -97% [16] depending on the techniques and procedures followed. Nonunion of fractured ends though less, can be expected [6,17].…”

Section: Post-operative Complicationmentioning

confidence: 99%

Does Closed Intramedullary Interlocking Nailing in Patients With Humeral Shaft Fractures Has Advantages: Evaluation Through a Clinical Study

Murari

Chandra

et al. 2017

Asian J Pharm Clin Res

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Objective: Intramedullary interlocking nail fixation (IINF) for the fracture shaft humerus (FSH) offers good clinical outcome. Evaluating the functional outcome of IINF in FSH and assessing the complications of the technique, time taken for fracture consolidation, and union rates were the objectives.Methods: Adult patients with a clinical diagnosis of diaphyseal fracture of humerus were assessed clinically and radiologically for the functional outcome of IINF in FSH. Functional outcome of shoulder and elbow considered together was graded as excellent, moderate, and poor. Daily assessment was done along with active physiotherapy. All were followed up at monthly intervals for 6-12 months or till the union of fracture. Radiological assessment was done at immediate post-operative period, at months 1, 3, 6, 9, and 12 months.Results: 30 patients (males n=24, 80%) with a mean(±standard deviation) age of 39(±13.31) years were included. Road traffic accident was the frequent cause (n=18, 60%). Indirect injury was the cause in 66.66% patients. Middle 1/3 rd of shaft of humerus was fractured in 53.33% patients. 10 (33.3%) patients each had oblique fracture and transverse fracture, respectively; comminuted fracture was seen in another 26.6% patients. Radial nerve palsy (10%) was the frequent associated injury of the total nine. The overall functional outcome was excellent in 80%, moderate in 16.6%, and poor in 3.3% patients. Postoperatively, nonunion, superficial infection and shoulder stiffness was seen in one patient each. Conclusion:IIFN is an excellent, least invasive surgical option for FHS with early fracture consolidation and better union rates.

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Humeral shaft fractures treated by interlocking nailing: a preliminary report on 16 patients

Cited by 37 publications

References 8 publications

Antegrade Humeral Nailing Through the Rotator Cuff Interval: A New Entry Portal

Antegrade Humeral Nailing Through the Rotator Cuff Interval: A New Entry Portal

The Locking Nail for the Humerus - Does it Fulfill the Expectations?

Does Closed Intramedullary Interlocking Nailing in Patients With Humeral Shaft Fractures Has Advantages: Evaluation Through a Clinical Study

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