Relationship of the Axillary Nerve to the Proximal Screws of a Flexible Humeral Nail System: An Anatomic Study

Albritton, Mark J.; Barnes, Christopher J.; Basamania, Carl J.; Karas, Spero G.

doi:10.1097/00005131-200307000-00004

Cited by 32 publications

(12 citation statements)

References 25 publications

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“…1,11,12 Antegrade insertion of the nail through the rotator cuff tendon will inevitably cause varying degrees of injury to the supraspinatus tendon and may lead to shoulder symptoms because of impingement syndrome, tendonitis, or even rotator cuff tear. 2,6,11,12 In our series, mild tenderness over the insertion portal was found in 9 patients, 5 had positive impingement signs, and 6 had a positive Jobe sign. The average strength of the supraspinatus on the operated side was significantly less than that of the contralateral side.…”

Section: Discussionmentioning

confidence: 46%

Treatment of proximal humeral fracture with a proximal humeral nail

Zhu

Wang

et al. 2010

Journal of Shoulder and Elbow Surgery

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Section: Discussionmentioning

confidence: 46%

Treatment of proximal humeral fracture with a proximal humeral nail

Zhu

Wang

et al. 2010

Journal of Shoulder and Elbow Surgery

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“…The culmination of bone density in subcortical areas puts emphasis on correct positioning of an intramedullary nail. While too proximal positioning bears the risk of irritation or even rupture of the rotator cuff, placing the implant too low could cause disadvantages regarding the resulting stability of the osteosynthesis [24-26]. As we expected, we encountered significantly higher densities for male donors in comparison to females for both bent and straight designs looking at all four subvolumes together.…”

Section: Discussionmentioning

confidence: 83%

Straight proximal humeral nails are surrounded by more bone stock in comparison to bent nails in an experimental cadaveric study

et al. 2014

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BackgroundIn the management of proximal humeral fractures intramedullary implants with bent and straight shape of the proximal part of nail are available. Based on data from previous studies on bone distribution in the humeral head, we hypothesized, that higher densities might exist in the bone stock surrounding straight nails in comparison to their angulated counterparts. With a known positive correlation between bone density and mechanical stability, this could indicate potentially higher rigidity of osteosyntheses done with straight implants.MethodsWe performed high resolution peripheral quantitative computed tomographies of the potential straight and bent implant bearing regions of 27 cadaveric proximal humeri. The acquired data were analyzed for differences between straight and bent Volumes of Interest as well as intra- and interindividual bone stock distribution.ResultsFor both straight and bent volumes of interest a considerably declining bone mineral density was found in craniocaudal direction. Mean densities of bent volumes were significantly lower in comparison to their corresponding straight counterparts (p < 0.01) Intra-individual comparison yielded high bivariate correlations of the corresponding Volumes of Interest of the right and the left side (p < 0.01).ConclusionsBased on the volumetric data a statistically relevant biomechanical superiority of straight shaped implants can be assumed. Since we found a rapid decrease of bone density in cranio-caudal direction, intramedullary implants should be anchored as proximally in the subcortical area as possible to minimize the risk of displacement or cutout. The high correlation between the Volumes of Interest of the corresponding right and left sides could aid in preoperative planning when considering an intra- or extramedullary approach.

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“…Vulnerable structures around the shoulder that could be injured during AHN include the axillary nerve, the circumflex artery, the long head of biceps, and the deltoid. These structures are usually injured by the proximal locking bolts, and modern targeting devices have not abolished this complication [14][15][16][17][18][19]. RHN is a technically demanding procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of retrograde versus Antegrade nailing in humeral diaphyseal fractures

Prasad¹,

Singh²,

Ingle³

et al. 2017

Int. J. Orthop. Sci.

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Introduction: DHF can be effectively treated by either antegrade or retrograde IMIL nailing and these is a relatively novel method of fracture fixation. These comparative study of two approaches on DHF using the same locked nails. Materials and Methods: Our comparative study we have selected 97 patients with DHF. Out of 97 patients,70 male and 27 females, age ranging from 22 to 70 for males and 20 to 60 for females, 69 right and 17 left, 75 closed and 22 grade I & II compound fractures, RHN nailing was done on 47 and AHN was done on 50 patients. Results: We analyzed the objective and subjective outcome of RHN and AHN in 97 cases of DHF in various age groups. All fractures unite in good anatomic position. No cases of deep infections but in 1 case there was a posterior cortical break which hasn't altered his all union time which was average 12 weeks. Neurapraxia was developed in 3 cases of AHN and in 1 case of RHN and there was no nerve entrapment in RHN. In one case of DHF, there was abrasions at the site of proximal screw insertion so proximal locking wasn't done and it was found that more amount of callus was formed comparatively. So proximal locking wasn't done in RHN. Conclusion: IMIL nailing in the management of DHF is that a 'fixed' nail can be inserted with both antegrade and retrograde techniques regardless of the fracture pattern and location. RHN is long learning curve and should be done very meticulously because posterior cortical break can lead to disastrous situation.

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Relationship of the Axillary Nerve to the Proximal Screws of a Flexible Humeral Nail System: An Anatomic Study

Cited by 32 publications

References 25 publications

Treatment of proximal humeral fracture with a proximal humeral nail

Treatment of proximal humeral fracture with a proximal humeral nail

Straight proximal humeral nails are surrounded by more bone stock in comparison to bent nails in an experimental cadaveric study

Comparative study of retrograde versus Antegrade nailing in humeral diaphyseal fractures

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