Intramedullary Nailing Of Humeral Fractures Research Articles

The elastic stable intramedullary nails as an alternative treatment for adult humeral shaft fractures.

Plate and locked intramedullary nailing for humeral fractures are golden standard procedure, but the humerus is a nonweight-bearing bone and can tolerate a larger range of acceptable alignment. We believe the elastic stable intramedullary nails (ESINs) can provide enough relative stability for humeral shaft fractures in certain adult patients. There are four new indications for using ESINs: (1) patient could not tolerate a sugar-tong splint but was a high risk for general anesthesia, (2) intramedullary canal narrowing (<7 mm), (3) long spiral or oblique fracture over the metadiaphyseal junction, and (4) obesity. All patients received retrograde fixation with two titanium elastic nails, except for one patient with a long spiral fracture over the proximal metadiaphysis. Patients had routine follow-up plain radiographs until bone union, and we evaluated functional results of patients by Mayo Elbow Performance Score and asked to complete Quick Disabilities of the Arm, Shoulder and Hand score at the last outpatient clinic visit. A total of 16 patients with a mean age of 54.4 years were included. The mean follow-up time was 14 ± 2.5 months, and the average time to bone union was 16 ± 4.3 weeks. There were no wound infections, loss of reduction, fracture nonunion, implant failure, or skin irritation expect for one nail back-out because of osteoporosis. We have reported good results using ESINs for the displaced fractures of the humerus in the four indication adults who would not be able to tolerate plate fixation or intramedullary nailing. The ESINs fixation method is a simple procedure that provides a small incision, minimal blood loss, short surgical time, and relative stability fixation.

Arthroscopic intramedullary nailing of humeral fractures through the rotator interval

IntroductionAntegrade nailing of humeral fractures is a proven technique with well-documented results. The standard surgical approach requires incision of the supraspinatus tendon to insert a nail, which comes with the risk of damaging the rotator cuff. The aims of this study were to describe a new surgical technique for arthroscopic humeral nailing that does not require opening the rotator cuff and to report the clinical and radiological outcomes of this technique. Materials and methodsThis was a single center, retrospective study of patients who had a humeral shaft or surgical neck fracture at our hospital in 2017 and underwent antegrade intramedullary nailing by arthroscopy. The nail was introduced through the rotator interval without opening the rotator cuff. All were reviewed at 1-year postoperative: clinical examination (joint range of motion and Constant score) plus AP and lateral radiographs of the shoulder. ResultsEighteen patients (12 women, 6 men) with a mean age of 65.4 years (37–84) were included retrospectively. One patient died during the follow-up period thus 17 patients were available for analysis. At the 1-year follow-up, the mean forward flexion was 152.1° (90–180), the mean external rotation was 56.1° (30-80), the mean absolute Constant score was 73.9 (54–88) points and the mean adjusted Constant score was 93.5 (67–100) points. Bone union was achieved in 16/17 patients (94%) with 1 patient experiencing a nonunion. There were no complications. ConclusionArthroscopic antegrade nailing of humeral shaft and surgical neck fractures through the rotator interval yields good clinical and radiological results in our hands. This new, rotator cuff-sparing technique is a viable option for treating humeral fractures by arthroscopy. Level of evidenceIV; retrospective study without control group.

Intramedullary Nailing of Humeral Head and Humeral Shaft Fractures.

There is an increasing interest in intramedullary nailing for humeral fractures. Starting with diaphyseal fractures, now also proximal metaphyseal fractures of the humerus can be nailed with satisfying results. Basic ideas for humeral nailing are less invasive approaches to the humerus, less soft tissue damage, e.g. lower rates of radial nerve palsy, closed reduction and the biomechanical aspects of a central implant with elastic fixation properties. Nailing of diaphyseal humeral shaft fractures is an equivalent alternative to plating; nailing of proximal metaphyseal humeral fractures is still new and needs more reliable scientific data to clear its advantages compared to other fixation techniques. Nailing of distal metaphyseal humeral fractures is no serious option at the moment. Angular stable interlocking systems show better fixation qualities for proximal fractures or fracture components. Although in very osteoporotic bone cutouts are registered. Static interlocking is advisable. High torsional stability of the fracture fixation has to be achieved, since significant torsional load occurs during the usual movement of the upper limbs. As there is an important learning curve, possible complications of intramedullary nailing have to be kept in mind and avoided by a careful operation technique.

Retrograde intramedullary nailing of humeral fractures with new implants. Analysis of 120 consecutive cases

Since 1993, 120 fractures of the humerus were treated by retrograde unreamed nailing. Operations were performed on simple, complex, compound and pathological fractures of the proximal three quarter of the humerus. On the proximal humerus, displaced two-part-fractures and occasionally three- or four-part-fractures were stabilized. In 110 cases a prototype of an unreamed humeral nail with deployable fins for proximal locking was employed. In another ten cases the new solid interlocking nail of the AO/ASIF was used. The operative procedure, rehabilitation program, complications and functional and radiological results are presented. Retrograde nailing offers a high patient comfort and good functional results (Constant-Score on average 87% of the opposite side). Complications were nail migration (8.3%), instability (3.8%), nonunions (5.8%) and iatrogenic fractures (5.8%). Patients with high grade osteoporosis, small proximal fragments and poor compliance have an increased rate of complications.