Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients

Sosef, Nico L.; Leerdam, Roderick van; Ott, Pieter; Meylaerts, S.A.G.; Rhemrev, Steven J.

doi:10.1007/s00402-009-1027-1

Cited by 29 publications

(22 citation statements)

References 25 publications

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“…It is important to note that, despite our re‐operation rate, our other complication rates are better than most published series. Our re‐operation rate of 21.3% compares to values of 17.2% to 38.9% [23,25,32]. Impingement has been reported in 1.9% to 38.9% of patients [23,26,27,32], greater tuberosity non‐union or malunion in 3.7% to 55.6% [23–27], screw back‐out in 3.4% to 7.4% [25,27,30], avascular necrosis (AVN) in 2.8% to 3.7% [25,26,30], intra‐articular screw protrusion in 7.4% to 17.6% [26,32], iatrogenic fracture in 17.2% [25], stiffness in 3.7% [30], infection in 0.9% to 8.8% [26,27,32] and transient radial nerve palsy in 4.2% [24].…”

Section: Discussionmentioning

confidence: 94%

Treatment of Proximal Humerus Fractures with the Stryker T2 Proximal Humeral Nail: A Study of 61 Cases

et al. 2013

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Background Surgical treatment of displaced proximal humerus fractures remains controversial. There is little guidance on which patients are likely to do well with humeral nailing. Therefore we present our study evaluating the Stryker T2 proximal humeral nail (T2-PHN).Methods Sixty-one consecutive patients with acute unilateral displaced proximal humerus fractures were treated with the T2-PHN and followed up for a mean of 19 months. There were 46 females and 15 males with mean age 68 (range 36-97). By Neer's classification there were 25 two-part, 28 three-part and 8 four-part fractures.Results Union occurred at a mean of 3 months. Fifty-five patients had Constant-Murley scores with a mean score of 64.9. Mean Constant-Murley was 59.9 for over 70s, 69.7 in under 70s, 68.0 in 2-part fractures, 67.5 in 3-part fractures, 36.6 in 4-part fractures, 50.6 in post-operative varus, 73.5 in post-operative neutral, 72.7 in post-operative valgus, 55.5 in medial metaphyseal comminution and 69.5 without comminution. Fifty-four patients had Oxford Shoulder scores with a mean score of 21.7. ConclusionsThe T2-PHN has a learning curve. Important points include adequate recessing of the nail tip and suturing of tuberosities. The best results can be expected in under 70s, 2 and 3-part fractures, patients without medial metaphyseal comminution and patients with neutral post-operative neck-shaft alignment.

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Section: Discussionmentioning

confidence: 94%

Treatment of Proximal Humerus Fractures with the Stryker T2 Proximal Humeral Nail: A Study of 61 Cases

et al. 2013

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“…Cuny et al [15] reported ten cases of revision surgery (15 %) for mechanical problems with the Telegraph nail and six cases of secondary tuberosity displacement. Sosef et al [16] in a series of 33 patients treated by Polaris nail, most of them for 2-PF, report 18 % revisions for mechanical problems; whereas Nolan et al [17], in a series of 18 patients with 2-and 3-PFs, with an average age of 71 years treated with Polaris nail, reported seven cases necessitating revision surgery (39 %) for mechanical problems.…”

Section: Discussionmentioning

confidence: 99%

Open reduction and internal fixation of three- and four-part proximal humeral fractures by intra-focal distraction: observational study of twenty five cases

Doursounian

Sant

Mauprivez

et al. 2016

International Orthopaedics (SICOT)

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“…A number of recent clinical series on IM nailing using specially designed nails have reported high union rates and satisfactory functional outcomes of treatment of proximal humeral fractures 1315). However, the use of IM nails for pathological proximal humeral fractures has not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several reports have been published on IM nail fixation techniques for proximal humerus fractures using devices that provide screw stabilization of the humeral head and tuberosity. They provide rigid fixation without extensive soft-tissue dissection 1213). In our patients, we applied an IM nailing technique, interlocking IM nailing with additional augmentation of the skeletal defect with bone cement, for pathological fractures of the proximal humerus.…”

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confidence: 99%

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

et al. 2016

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BackgroundEndoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes.MethodsWe reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes.ResultsThe mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up.ConclusionsProximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.

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Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients

Abstract: Minimally invasive fixation of displaced 2-part and 3-part humeral fractures in an elderly population shows satisfactory to excellent results in 80% of patients.

Cited by 29 publications

References 25 publications

Treatment of Proximal Humerus Fractures with the Stryker T2 Proximal Humeral Nail: A Study of 61 Cases

Treatment of Proximal Humerus Fractures with the Stryker T2 Proximal Humeral Nail: A Study of 61 Cases

Open reduction and internal fixation of three- and four-part proximal humeral fractures by intra-focal distraction: observational study of twenty five cases

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

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