Intramedullary Nailing of Humeral Shaft Fractures: Percutaneous Nailing in the lateral position through the Neviaser approach is a reliable Technique

Abstract

BackgroundDisplaced humeral shaft fractures are frequently treated by osteosynthesis in the active patient. We aimed to evaluate the results of intra-medullary nailing (IMN) in the lateral position with the Neviaser approach and to compare them with those from IMN nailing in the standard position and conventional approach. MethodsIn the retrospectively evaluated, single-center study, we compared 20 cases of long IMN for fractures of the proximal or middle third of the humerus shaft (Multilock; Synthes Laboratory) in the lateral position with the percutaneous Neviaser approach with 52 cases of IMN in the standard position. The mean age of patients was 62+/-21 years. Clinical outcomes were analyzed: Constant score, subjective shoulder evaluation (SSV) score and range of motion (ROM). Radiographically, entry point at the proximal part of the humerus, the healing rate and the possible association between the critical shoulder angle (CSA) and the correct positioning of the nail were assessed. ResultsWith a mean follow-up of 26+/-2 months, the healing rate was 89% (64/72) in the overall series, (8 patients in non-union), with no difference between the 2 groups. The overall mean active anterior elevation (AAE) was 125+/-22 degrees, mean external rotation (ER1) was 35+/-17 degrees, and mean internal rotation (IR) was at L3. The mean Constant score was 58+/-23 and SSV score 73+/-12%. ROMs were better in the lateral than standard position group (AAE 133+/-17 vs 122+/-23, p=0.03; ER1 47+/-13 vs 30+/-16, p<0.001; IR T12 vs L5, p=0.02). The nail was less often protruding in the lateral than standard position group (1/20 [5%] vs 20/52 [38.5%], p=0.002). The nail was better positioned from the anteroposterior view (nail centered: 16/20 [75%] vs 26/52 [50%], p=0.047) and lateral view (nail centered: 18/20 [90%] vs 34/52 [65.4%], p=0.02) in the lateral than standard position group. We found no association between nail position, type of approach and CSA. ConclusionsIn the short-term follow-up, osteosynthesis of humeral shaft fractures by using long IMN in the lateral position with the Neviaser approach is a reliable technique. The positioning of the nail, in particular its entry point, and the clinical results were better with the lateral position and Neviaser approach than with the standard position and conventional approach. Further studies with a larger number of patients, assessment of the learning curve, and analysis of the impact of this technique on comorbidities (unchanged cerebral perfusion) are needed to fully validate this technique.