Straight proximal humeral nailing: Risk of iatrogenic tendon injuries with respect to different entry points in anatomical specimens

Schwarz, Angelika; Hohenberger, Gloria; Euler, Simon A.; Weiglein, Andreas; Riedl, Regina; Kuchling, Sabine; Krassnig, Renate; Plecko, Michael

doi:10.1016/j.injury.2018.07.007

Cited by 7 publications

(3 citation statements)

References 36 publications

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“…Second, we only evaluated the risk of injury to the SSP-F, without considering other rotator cuff tendons. For example, Schwarz et al 26 observed iatrogenic infraspinatus tendon footprint injury rate was 62.5% (25 of 40) when SAHN was placed medial to the standard entry point at the center of the humeral head. Third, the use of MRI in the evaluation of fractures is under development.…”

Section: Discussionmentioning

confidence: 99%

Straight antegrade humeral nailing and risk of iatrogenic injury of supraspinatus tendon footprint: An MRI study

et al. 2023

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Background Straight antegrade humeral nailing (SAHN) is associated with excellent clinical results in proximal humerus fractures. The optimal entry point is the top of the humeral head. However, the anatomy is variable, and the entry point can affect supraspinatus tendon footprint (SSP-F) or fracture reduction. The aim of this study was to analyze the relationship between the SSP-F and SAHN entry point by analyzing magnetic resonance imaging (MRI) studies of the humerus. Methods In total 58 MRI studies of entire humerus were reviewed. The mean age was 51.6 ± 12.4 years, with 40 female patients. The distance between the SSP-F and the SAHN insertion point (critical distance: CD), the width of the footprint, and the neck-shaft angle (NSA) were measured. Univariate and multivariate analysis were performed. Results The mean CD was 7.51 mm ± 2.81 (0–12.9 mm) with 51.7% of proximal humerus “critical type” (CD <8 mm). The CD was found to be lower in females, with no difference found with varying age (62.5% “critical type”). CD correlated with NSA (linear regression). “Critical type” correlated with female gender and NSA (logistic regression). Discussion More than half of the humerus are “critical types” as to SAHN and may, therefore, be at risk for procedure-related complications.

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Section: Discussionmentioning

confidence: 99%

Straight antegrade humeral nailing and risk of iatrogenic injury of supraspinatus tendon footprint: An MRI study

et al. 2023

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“…This could theoretically decrease the incidence of postoperative cuff tendinopathy [ 21 ]. Schwarz et al compared the risk of iatrogenic tendon damage on a cadaveric model in 40 humeri showing that the lesions to the infraspinatus and long head of biceps tendons were different depending on the entry point [ 26 ]. A randomized clinical trial comparing straight and curvilinear design nails was published by Lopiz et al in 2014 [ 27 ].…”

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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“…Further on, a calcar screw is introduced to increasing construct stability, which will play an important role in maintaining fracture reduction. Standard entry points in line with the humeral shaft axis could significantly reduce implant-related injuries to the adjacent anatomical structures in anatomical specimens [ 16 ]. Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with locking plate designs in a biomechanical study [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Straight intramedullary MultiLoc nails for displaced proximal humeral fractures: health status, radiographic results, clinical outcome, and complications

Chen,

Zhang,

Zhu

et al. 2024

BMC Musculoskelet Disord

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Background The treatment of the displaced proximal humerus fractures (PHF) still facing a lot of unsolved problems. The aim of this study was to evaluate the clinical effect of MultiLoc nails for the treatment of PHF and present outcomes of patients with different Neer’s classification and reduction quality. Methods Adult patients with PHFs were recruited and treated with MultiLoc nail. Intraoperative data, radiographic and functional outcomes, as well as occurrence of postoperative complications were assessed. Results 48 patients met inclusion and exclusion criteria and were included in this study. The DASH Score were 32.2 ± 3.1 points at 12 months, and 37.3 ± 2.5 points at the final follow-up. The mean ASES score at 12 months and final follow-up were 74.4 ± 6.2 and 78.8 ± 5.1, respectively. The mean CM Score in all 48 patients reached 68 ± 6.4 points at the final follow-up, relative side related CM Score 75.2 ± 7.7% of contralateral extremity. The incidence rate of complications was 20.8%. Patients with fracture mal-union, adhesive capsulitis were observed but no secondary surgeries were performed. There was no significantly difference of DASH Score 12 months after surgery and at the last follow-up among patients with different Neer’s classification or reduction quality. However, functional outcomes such as ASES score and CM score were significantly influenced by severity of fracture and the quality of fracture reduction. Conclusions Our study demonstrated that MultiLoc nails is well suited for proximal humeral fractures, with satisfactory health status recovery, good radiographic results, positive clinical outcomes and low rates of complications. The treatment for four part PHF still faces great challenges. Accurate fracture reduction was an important factor for good functional result.

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Straight proximal humeral nailing: Risk of iatrogenic tendon injuries with respect to different entry points in anatomical specimens

Cited by 7 publications

References 36 publications

Straight antegrade humeral nailing and risk of iatrogenic injury of supraspinatus tendon footprint: An MRI study

Straight antegrade humeral nailing and risk of iatrogenic injury of supraspinatus tendon footprint: An MRI study

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

Straight intramedullary MultiLoc nails for displaced proximal humeral fractures: health status, radiographic results, clinical outcome, and complications

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