Operative treatment of 2-part surgical neck type fractures of the proximal humerus in the elderly: Cement augmented locking plate PHILOS™ vs. proximal humerus nail multiloc®

Helfen, Tobias; Siebenbürger, Georg; Fleischhacker, Evi; Gleich, Johannes; Böcker, Wolfgang; Ockert, Ben

doi:10.1016/j.injury.2020.06.026

Cited by 24 publications

(15 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hessmann et al reported good results after antegrade fixation with a straight design nail at short term follow up (6 months) with a mean Constant-Murley score of 66.1, mean forward flexion of 134° and mean abduction of 125° and with a 100% of radiographic healing [ 23 ]. 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 ].…”

Section: Discussionmentioning

confidence: 87%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 87%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The Multiloc intramedullary nail adds to the calcar screw design to provide better support for patients with large proximal medial cortical defects [ 19 ]. Several previous studies demonstrated the biomechanical advantages of the intramedullary nail [ 14 – 16 , 20 ]. There is a high risk of secondary displacement and fracture nonunion in elderly patients with poor bone quality.…”

Section: Discussionmentioning

confidence: 99%

Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures

et al. 2022

View full text Add to dashboard Cite

Background The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance. Methods Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant. Results A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up. Conclusion Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.

show abstract

“…Proximal humeral fracture (PHF) affects patient health and is the third most common fracture in the elderly [ 1 , 2 ]. As population demographics continue to change, the incidence of proximal humeral fracture is expected to increase by 50% in 2030 [ 3 ]. Osteoporotic fractures are characterized by loss of bone mass and deterioration of bone microarchitecture and have put a great burden on medical expenses [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Morphological characteristics of the surgical neck region in the proximal humerus at different ages

et al. 2022

View full text Add to dashboard Cite

Background The objective of the study was to demonstrate the cortical thickness character in the humeral surgical neck region using 3D cortical bone mapping technique and try to illustrate its morphological changes with age. Material and methods Normal individuals, including 11 volunteers younger than 18 years, 87 adult men and 46 adult women, were enrolled. The cortical thickness and height of the surgical neck region was measured with Mimic and 3 Matic software. The height of the region was compared and measured. People with an age of 18–30 years was identified as Group I, people in 31–40 years as Group II, people in 41–50 years as Group III, people in 51–60 years as Group IV, and Group V including people ≥ 61 years. Results Compared with the baseline Group I, cortical thickness was significantly decreased by 0.52 mm (P = 0.006) in Group III, by 0.76 mm (P < 0.001) in Group IV, and by 0.77 mm (P < 0.001) in Group V. Age moderately predicted cortical thickness with r = −0.5481. The height of the cortical change region was significantly decreased by 2.25 mm (P = 0.007) in Group II, by 2.98 mm (P < 0.001) in Group III, and by 2.07 mm (P = 0.02) in Group IV. However, no significant decrease was illustrated in Group V (0.57 mm) (P = 0.891). The relation between age and the height of the cortical thickness change region was nonlinear. Conclusions This study identified an obvious decrease in cortical thickness with aging, and the height was curve fitted with aging in surgical neck region.

show abstract

Operative treatment of 2-part surgical neck type fractures of the proximal humerus in the elderly: Cement augmented locking plate PHILOS™ vs. proximal humerus nail multiloc®

Cited by 24 publications

References 39 publications

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

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

Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures

Morphological characteristics of the surgical neck region in the proximal humerus at different ages

Contact Info

Product

Resources

About