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Lopiz Y, Garríguez-Pérez D, Martínez-Illán M, García-Fernández C, Marco F. Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications. Arch Orthop Trauma Surg 2022; 142:227-238. [PMID: 33175196 DOI: 10.1007/s00402-020-03678-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients. METHODS A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12 months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS. RESULTS Mean age was 82.1 (range 80-90) and mean follow-up was 45.6 months (range 16-53 months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck-shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively. CONCLUSION Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain. .,Department of Surgery, Complutense University, Madrid, Spain.
| | - Daniel Garríguez-Pérez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain
| | - Marina Martínez-Illán
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital. 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N 28004, Madrid, Spain.,Department of Surgery, Complutense University, Madrid, Spain
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Jia Z, Li C, Lin J, Liu Q, Li G, Hu X. Clinical effect of using MultiLoc® nails to treat four-part proximal humeral fractures. J Int Med Res 2021; 48:300060520979212. [PMID: 33334211 PMCID: PMC7750834 DOI: 10.1177/0300060520979212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective This study was performed to evaluate the clinical effect of MultiLoc® nails
(DePuy Synthes, Raynham, MA, USA) on the treatment of four-part proximal
humeral fractures (PHFs). Methods From January 2014 to January 2018, 32 patients with four-part PHFs were
treated with intramedullary MultiLoc® nails in our hospital. The operation
time, bleeding volume, postoperative X-ray findings, and fracture healing
status were recorded and analyzed. At the end of follow-up, the clinical
outcome was evaluated based on the visual analog scale (VAS) score, American
Shoulder and Elbow Surgeons (ASES) shoulder score, Constant–Murley score
(CMS), and occurrence of any complications. Results Among all patients, the average operation time was 124.5 minutes (range,
91–152 minutes), the average amount of bleeding was 90 mL (range, 55–150
mL), and the fracture healing rate was 100%. At the end of follow-up, the
mean VAS score was 1.6 ± 0.4, mean ASES score was 84.4 ± 6.3, and mean CMS
was 70.3 ± 6.1; no serious complications had occurred; and the patients
exhibited good recovery of shoulder function. Conclusions MultiLoc nails® can be applied to the treatment of four-part PHFs. This
surgical fixation method has no obvious complications and helps to restore
shoulder function.
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Affiliation(s)
- Zhaofeng Jia
- Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Chuangli Li
- Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Jiandong Lin
- Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Qisong Liu
- Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Guangheng Li
- Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Xinjia Hu
- Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province, China
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Congia S, Palmas A, Marongiu G, Capone A. Is antegrade nailing a proper option in 2- and 3-part proximal humeral fractures? Musculoskelet Surg 2020; 104:179-185. [PMID: 31183680 DOI: 10.1007/s12306-019-00610-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To report our experience with antegrade short locked intramedullary nail for treatment of proximal humeral fractures and to review the current literature. MATERIALS AND METHODS From January 2012 to July 2013, 41 patients affected by two and three-part proximal humeral fractures were treated with surgical internal fixation with short locked intramedullary nails. Outcome analysis included standard clinical follow-up, Constant shoulder score and plain radiographs. The mean follow-up was 30 months (range 24-42). Moreover, a review of the literature was carried out. RESULTS The mean Constant shoulder score was 81.5, excellent functional outcomes in 24/38 patients. All the fractures healed in an average time of 3.7 months. Five patients underwent additional operations, complications included hardware penetration into the joint (n = 2), backed out screw (n = 1), shoulder impingement due to protrusion of the nail (n = 2) and superficial infection (n = 1). The literature review showed 530 patients affected by proximal humeral fracture and treated with intramedullary nail with mean age of 65 years, mean follow-up of 22.2 months and a Constant shoulder score of 72.9 points; the major complications reported were backing out of the screws, shoulder impingement and joint protrusion of the screws. CONCLUSIONS Antegrade short locked intramedullary nail allows stable fixation, minimal soft tissue dissection, early mobilization of the shoulder and good outcomes. It is an efficacious therapeutic solution for 2- and 3-part proximal humeral fractures.
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Affiliation(s)
- S Congia
- Clinica Ortopedica, Università degli Studi di Cagliari, Viale Lungo Mare Poetto 12, 09100, Cagliari, Sardegna, Italy.
| | - A Palmas
- Clinica Ortopedica, Università degli Studi di Cagliari, Viale Lungo Mare Poetto 12, 09100, Cagliari, Sardegna, Italy
| | - G Marongiu
- Clinica Ortopedica, Università degli Studi di Cagliari, Viale Lungo Mare Poetto 12, 09100, Cagliari, Sardegna, Italy
| | - A Capone
- Clinica Ortopedica, Università degli Studi di Cagliari, Viale Lungo Mare Poetto 12, 09100, Cagliari, Sardegna, Italy
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Deng XY, Fan ZY, Yu BF, Ni BB, Wang W, Lu H, Shen H. Use of a locking intramedullary nail for the treatment of initial varus proximal humeral fracture: a prospective pilot study. J Int Med Res 2020; 48:300060520935286. [PMID: 32588694 PMCID: PMC7323304 DOI: 10.1177/0300060520935286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the feasibility of locked intramedullary nailing, rather than locking plate fixation combined with fibular allograft augmentation, for initial varus proximal humeral fractures. Methods This prospective pilot study enrolled patients with initial varus proximal humeral fractures that were treated with a locking intramedullary nail. Radiography was performed to evaluate fracture healing. Data about the visual analogue scale (VAS) pain score, Constant Shoulder Score (CSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) were recorded. Results Twenty patients, including eight with Neer two-part and 12 with three-part fractures, were followed-up, with a mean time of 12.3 months. All patients sustained fractures that healed without re-varus. During the last follow-up, the shoulder function of the patients had recovered well, with a mean VAS pain score of 1.4, a mean CSS of 83.1, a mean DASH score of 80.8, a mean ASES score of 84.0 and a satisfactory ROM. In one patient, the proximal locking screw came out and was removed via a second surgery. Conclusions The use of a locking intramedullary nail alone for initial varus proximal humeral two-/three-part fractures was feasible. This treatment has advantages, such as preventing re-varus and causing milder surgical trauma, than that seen with a locking plate.
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Affiliation(s)
- Xiang-Yi Deng
- Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhi-Yuan Fan
- Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bao-Fu Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin-Bin Ni
- Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hua Lu
- Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Shen
- Department of Orthopaedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Bungartz M, Matziolis G, Rohe S, Brinkmann O. Multifragmentary dislocated humeral head fracture-A case report of a successful head preserving treatment strategy despite delayed presentation. Int J Surg Case Rep 2016; 29:63-66. [PMID: 27816690 PMCID: PMC5099258 DOI: 10.1016/j.ijscr.2016.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/25/2022] Open
Abstract
Case report of multifragmentary and luxated humeral head fracture treated headpreserving despite delayed surgery (120 h). “Avoiding arthroplasty inspite of extrmely high risk of avascular necrosis due to compromised blood supply in luxation oft he humeral head. The headpreserving treatment showed excellent functional and radiologic results keeping a high “quality of life level”. Divergent from the recommended standard−treatment (trauma arthroplasty) of luxated humeral headsplit fractures in a “delayed situation” a head preserving option should be taken into consideration.
Introduction Head preserving, delayed osteosynthesis five days after a luxated, multifragmentary humeral head fracture is rarely seen and a challenge for the surgeon. Presentation of case This case history describes the case of a 69-year-old female with delayed head preserving treatment of a dislocated multifragmentary humeral head fracture using intramedullary nailing, avoiding a primary trauma arthroplasty after strict refusal of the patient despite poor prognosis and high risk of avascular humeral head necrosis. Discussion The treatment of the humeral head fracture is still a matter of debate, the “golden standard” does not exist, especially in the deferred luxated situation. With the use of modern implants head preserving treatment is reasonable and possible. It should therefore always be taken into account as an alternative for arthroplasty. Conclusion Excellent postoperative outcome can be achieved by joint reconstruction eliminating the possible side effects of shoulder endoprosthesis.
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Affiliation(s)
- Matthias Bungartz
- Orthopaedic Department, Campus Eisenberg, Friedrich-Schiller University, Jena, Germany.
| | - Georg Matziolis
- Orthopaedic Department, Campus Eisenberg, Friedrich-Schiller University, Jena, Germany
| | - Sebastian Rohe
- Orthopaedic Department, Campus Eisenberg, Friedrich-Schiller University, Jena, Germany
| | - Olaf Brinkmann
- Orthopaedic Department, Campus Eisenberg, Friedrich-Schiller University, Jena, Germany
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