Intramedullary nailing of displaced four-part fractures of the proximal humerus

Kloub, Martin; Holub, K; Urban, J; Látal, Pavel; Peml, Marek; Křivohlávek, M

doi:10.1016/j.injury.2019.06.029

Cited by 21 publications

(23 citation statements)

References 14 publications

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“…In addition to surgical treatment, early functional training for fracture patients is an important method, but joints need to be fixed for a period of time after internal fixation surgery. As reported [ 14 , 15 ], after fixation surgery, the muscle contraction function is greatly reduced, which can cause muscle stiffness, tissue adhesion, muscle atrophy, etc., affecting the recovery of joint function. Sling fixation is a common fixation method.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Clinical Effect of New Shoulder Joint Abduction Frame in Humeral Fracture Patients after Arthroscopic Shoulder Surgery

Yu¹,

Min²,

Liu³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. This work is organized to analyze the clinical effects of new shoulder joint abduction frame on the bone metabolic markers, shoulder joint function, and visual analogue scale (VAS) of humeral fracture patients undergoing arthroscopic surgery. Methods. 118 patients with humeral fracture who planned to undergo shoulder surgery in our hospital from November 2018 to June 2021 were selected as the study objects and were divided into two groups according to the random number method, with 59 patients in each group. The patients in the two groups were subjected to arthroscopic shoulder surgery. New shoulder joint abduction frame was used for shoulder joint fixation in the abduction frame group, and sling was used for shoulder joint fixation in the sling group after surgery. The duration of fixation was 4-6 weeks. Finally, the prognostic indicators, complications, and serum bone metabolism levels in 4 and 6 weeks after surgery, shoulder joint function (Neer score), VAS score before surgery and after 3 and 6 months of surgery, and excellent or good rate of shoulder joint activity after 6 months of surgery were compared between the two groups. Results. The postoperative fracture healing time and start time of shoulder joint training were shorter, and the humeral varus angle and femur height loss were smaller in the abduction frame group than in the sling group ( P < 0.05 ). There was no significant difference in the total incidence of complications between the two groups (3.39% and 13.56%, respectively) ( P > 0.05 ). After 4 or 6 weeks of surgery, the levels of serum osteoprotegerin (OPG) and carboxyterminal propeptide of type I procollagen (PICP) were increased but the levels of tartrate-resistant acid phosphatase-5B (TRAP-5B) were decreased in the two groups with more significant differences in the abduction frame group ( P < 0.05 ). After 6 months of follow-up, 2 cases were lost to follow-up in the abduction frame group and 3 cases in the sling group. Neer scores were increased, while VAS scores were decreased in the two groups in the third or sixth months after surgery with significant differences in the abduction frame group ( P < 0.05 ). The excellent or good rate of shoulder joint activity was 94.74% (54/57) in the abduction frame group, significantly higher than that in the sling group (80.36%; 45/56) ( P < 0.05 ). Conclusion. The fixation effect of new shoulder joint abduction frame is significant after arthroscopic surgery, and patients can carry out functional training as early as possible, which is helpful to promote fracture healing, relieve pain, and restore shoulder joint function with high safety.

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Section: Discussionmentioning

confidence: 99%

Investigation of the Clinical Effect of New Shoulder Joint Abduction Frame in Humeral Fracture Patients after Arthroscopic Shoulder Surgery

Yu¹,

Min²,

Liu³

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Humeral nails design have had many technical developments in the last decades and now its indication has extended to many fracture patterns [ 7 , 21 – 24 ]. Chronic shoulder pain is a common complication after antegrade humeral nailing.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover the recent work of Helfen et al demonstrated good functional outcomes using straight design nails in 2-part fractures of the proximal humerus: both functional outcome and radiographic evaluation were satisfactory at 24 months of follow up, comparable to results achieved with the use of a locking plate fixation [ 32 ]. Kloub et al also described satisfactory results of the use of a straight design nail even in 4-part fractures of the proximal humerus: in a cohort of 35 patients at 25,8 months of follow up a relative side related Constant-Murley score of 66.8% was obtained, with only 6 cases of avascular necrosis of the humeral head [ 24 ]. Muccioli et al reported good clinical and radiographic outcomes in 40 patients treated with new generation straight design nails (34 Aequalis Tornier Wright and 6 Multiloc Depuy Synthes) with a mean Constant-Murley score of 70 ± 17 at 8 months of follow up.…”

Section: Discussionmentioning

confidence: 99%

Newer generation straight humeral nails allow faster bone healing and better functional outcome at mid-term

et al. 2021

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Purpose Although proximal and diaphyseal humerus fractures are frequent, the optimal management remains controversial. Antegrade nailing prevents further damage to the soft tissues and to the vascularization, but it has been associated with postoperative shoulder pain and dysfunction. During the latest years a straight nail design was developed to minimize these problems. Methods A total of 243 patients who had undergone surgery for antegrade intramedullary humeral nailing between January 2013 and July 2018 in A. Gemelli Trauma Center were divided into two groups according to the nail design used: straight nail group (S-group) and curvilinear nail group (C-group). Clinical data were collected using assessment forms (SF12-v2, Quick-DASH, ASES and Constant-Murley). Radiographic bone healing was assessed with RUST score at 30, 90 and 180 days after surgery. Results The S-group was made up of 128 patients with a mean age of 59 ± 19 (range 18–97) and a mean follow-up of 46 ± 9 months. The C-group was made up of 115 patients with a mean age of 53 ± 16 (range 18–88) and a mean follow-up of 51 ± 8 months. The S-group had a mental component summary (MCS) score of 54.3 ± 7.7 and a physical component summary (PCS) score of 46 ± 10.2, the C-group had a MCS score of 50.9 ± 8.4 and a PCS score of 44.1 ± 7.4. Quick-DASH and ASES were respectively 18.8 ± 4.3 and 78.6 ± 8.2 in the S-group, 28.3 ± 11.6 and 72.1 ± 13.5 in the C-group with statistical significance. Constant-Murley score was 73.9 ± 9.1 in the S-group (76% of the contralateral healthy side) and 69.4 ± 10.4 in the C-group (73% of the contralateral healthy side). The radiographic union score in the S-group was 4.1 ± 0.3 at 30 days after surgery, 7 ± 0.8 at 90 days and 10 ± 1.2 at 180 days, while in the C-group it was 4.2 ± 0.4 at 30 days, 6.4 ± 0.7 at 90 days and 9 ± 0.9 at 180 days. Conclusion Newer generation straight nails allow a faster bone healing and better functional outcome at mid-term follow up. Level of evidence III.

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“…Kloub et al [15] showed that the quality of the reduction is an important factor of determining the risk of humeral head necrosis (HHN). HHN was observed in only 2% of fractures with good reductions, but in 60% of fractures with bad reductions.…”

Section: Discussionmentioning

confidence: 99%

Reverse Shoulder Arthroplasty Versus Antegrade Nailing for 3- and 4-Part Proximal Humeral Fractures in Elderly Patients.

Amri

Ayari

TLEMSANI

et al. 2020

Preprint

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Introduction: Proximal humerus fractures are prevalent and widespread, accounting for 5% of all fractures, mainly in the elderly osteoporotic patients following a low-level trauma. Three-and four-part fractures represent 13 to 16% of these fractures and are generally associated with a worse prognosis. Depending on the fracture type and the patient status, several therapeutic options would be available ranging from osteosynthesis to arthroplasty. The aim of our study was to compare the functional and radiological results, as well as the complications of reverse shoulder arthroplasty and anterograde nailing when managing these fractures. Methods: A retrospective and descriptive study was conducted within the orthopedic surgery department of the Military Hospital of Instruction of Tunis, over a period of 42 months, from January 2016 to June 2019 with an average follow-up of 18 months. We included 31 cases of complex fractures of the proximal humerus in elderly patients, aged over 65 years, 16 of whom were treated by reverse total arthroplasty and 15 by antegrade nailing. Results: Our patient pool included 8 men and 23 women with a mean age of 73 years, ranging from 65 to 85. A low-energy fall was the main cause of the fractures with the dominant side being affected in 55% of cases. Four-part fractures were predominant representing 68% of the fractures. Constant and DASH scores at the last follow-up were at 68 and 24 respectively. Most patients were satisfied with the outcome of their surgeries, with an overall satisfaction rate of 87%. The complications rate was in accordance with the literature. Functional results in the group treated with reverse total shoulder arthroplasty were better with a lower complications rate. Conclusion: Reverse total shoulder arthroplasty has become an interesting surgical alternative, as the functional and anatomical results in our study were promising, while elucidating an improved quality of life for our patients. These findings have encouraged us to continue using this technique as a first-line choice for complex fractures of the proximal humerus in the elderly

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Intramedullary nailing of displaced four-part fractures of the proximal humerus

Cited by 21 publications

References 14 publications

Investigation of the Clinical Effect of New Shoulder Joint Abduction Frame in Humeral Fracture Patients after Arthroscopic Shoulder Surgery

Investigation of the Clinical Effect of New Shoulder Joint Abduction Frame in Humeral Fracture Patients after Arthroscopic Shoulder Surgery

Newer generation straight humeral nails allow faster bone healing and better functional outcome at mid-term

Reverse Shoulder Arthroplasty Versus Antegrade Nailing for 3- and 4-Part Proximal Humeral Fractures in Elderly Patients.

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