Intramedullary Cage Fixation for Proximal Humerus Fractures Has Low Reoperation Rates at 1 Year: Results of a Multicenter Study

Goodnough, L. Henry; Campbell, Sean T.; Githens, Thomas; DeBaun, Malcolm R.; Bishop, Julius A.; Gardner, Michael J.

doi:10.1097/bot.0000000000001712

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…The proximal humerus cage, consisting of a fixed angle expandable nitinol cage incorporating locked fixation, has been one modality of supplemental fixation used to reduce fixation failure. 38 In a multicenter study by Goodnough et al, 39 the use of the proximal humerus cage demonstrated an overall complication rate of 19.1%, with a 1-year revision surgery rate of 7.7%, which the authors noted is less than that typically seen with conventional locked plating. In a recent study by Cui et al, 40 23 patients were treated with proximal humerus locking plates in addition to a spine cage and compared with 39 patients treated with a locking plate only.…”

Section: Tips To Optimize Resultsmentioning

confidence: 96%

Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures

Brodke

Gurbani

Lee

2023

J Am Acad Orthop Surg

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The surgical treatment of proximal humerus fractures, though common, is associated with surprisingly high complication rates upward of 34%. Obtaining a reduction and placing a stable fixation can be challenging because many fractures treated surgically are comminuted and occur in osteoporotic bone. Nevertheless, innovations in technique and implant design are mitigating some failures. These innovations include the use of fibular strut allograft and other fixation adjuncts, the correct placement of calcar screws and other locking fixation, and having a systematic approach to reduction and intraoperative imaging to ensure the restoration of anatomy. This review and accompanying video highlight various technical strategies to maximize the success of surgical treatment for these challenging injuries.

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Section: Tips To Optimize Resultsmentioning

confidence: 96%

Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures

Brodke

Gurbani

Lee

2023

J Am Acad Orthop Surg

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“…However, the biomechanical study did not show significant differences comparing with the conventional locking plate [ 25 ]. Clinical studies have used titanium mesh or intramedullary cages to enhance the stability of plate fixation, and encouraging results have been achieved at 1-year follow-up [ 26 , 27 ]. However, fundamental technological innovations developed specifically for complex PHF with osteoporosis have rarely been reported.…”

Section: Discussionmentioning

confidence: 99%

Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults

Bai

Zhu

Chang

et al. 2022

BMC Musculoskelet Disord

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Background Internal fixation of complex proximal humeral fractures (PHF) with osteoporosis is associated with a high incidence of complications. This study introduces the technique and clinical results of a novel intramedullary support nail and plate system (ISNPs) for the internal fixation of 3- or 4- part PHF in older adults. The ISNPs combines the concept of intramedullary support and dynamic fixation into a locking plate fixation system that can be applied using a minimally invasive surgical approach. Methods A total of 46 consecutive patients diagnosed with 3- or 4-part PHF that met the criteria were included in this study, including 18 in the ISNPs group and 28 in the conventional locking plate (LP) group. Clinical results, including operative time, intraoperative bleeding, reduction quality, subjective outcome ratings, and complications, were compared between the two groups. Functional outcomes were evaluated using the Constant score and disability of the arm, shoulder, and hand (DASH) questionnaire at 1-year follow-up. Results There were no significant differences in age, sex, local bone quality, Neer-fracture type, and follow-up time between the ISNPs and LP groups. For clinical analysis, there were no significant differences in intraoperative bleeding and operation time between the ISNPs and LP groups. Significant differences were observed in the percentage of the malreduced cases, Constant and DASH score analysis, and the patients’ subjective evaluation (‘excellent’ and ‘good’ %) between the two groups. Conclusion The ISNPs technique proposed in this study provides a novel hybrid internal fixation model for complex PHF with osteoporosis. The clinical results at 1-year follow-up confirmed the advantage of applying it to 3- or 4- part PHF in older patients. Further studies are required to optimize its design and explore its optimal indications.

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“…However, the biomechanical study did not show signi cant differences comparing with the conventional locking plate [25]. Clinical studies have used titanium mesh or intramedullary cages to enhance the stability of plate xation, and encouraging results have been achieved at 1-year follow-up [26,27]. However, fundamental technological innovations developed speci cally for complex PHF with osteoporosis have rarely been reported.…”

Section: Discussionmentioning

confidence: 99%

Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults

Bai

Zhu

Chang

et al. 2022

Preprint

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Background: Internal fixation of complex proximal humeral fractures (PHF) with osteoporosis is associated with a high incidence of complications. This study introduces the technique and clinical results of a novel intramedullary support nail and plate system (ISNPs) for the internal fixation of 3- or 4- part PHF in older adults. The ISNPs combines the concept of intramedullary support and dynamic fixation into a locking plate fixation system that can be applied using a minimally invasive surgical approach.Methods: A total of 46 consecutive patients diagnosed with 3- or 4-part PHF that met the criteria were included in this study, including 18 in the ISNPs group and 28 in the conventional locking plate (LP) group. Clinical results, including operative time, intraoperative bleeding, reduction quality, subjective outcome ratings, and complications, were compared between the two groups. Functional outcomes were evaluated using the Constant score and disability of the arm, shoulder, and hand (DASH) questionnaire at 1-year follow-up.Results: There were no significant differences in age, sex, local bone quality, Neer-fracture type, and follow-up time between the ISNPs and LP groups. For clinical analysis, there were no significant differences in intraoperative bleeding and operation time between the ISNPs and LP groups. Significant differences were observed in the percentage of the malreduced cases, Constant and DASH score analysis, and “excellent” and “good” ratings between the two groups. Conclusion: The ISNPs technique proposed in this study provides a novel hybrid internal fixation model for complex PHF with osteoporosis. The clinical results at 1-year follow-up confirmed the advantage of applying it to 3- or 4- part PHF in older patients. Further studies are required to optimize its design and explore its optimal indications.

show abstract

Intramedullary Cage Fixation for Proximal Humerus Fractures Has Low Reoperation Rates at 1 Year: Results of a Multicenter Study

Cited by 8 publications

References 25 publications

Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures

Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures

Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults

Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults

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