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Antegrade Rush nailing for fractures of humeral shaft- an analysis of 200 cases with an average follow up of 1 year  [cached]
Gadegone W,Salphale Yogesh
Indian Journal of Orthopaedics , 2006,
Abstract: Background : The incidence of humeral fracture has significantly increased during the recent times due to the rising age of the population and the number of automobile accidents. In order to achieve a stable fixation and early mobilization, numerous surgical implants have been devised. Method : We carried out a prospective analysis of the data of 200 consecutive patients who had closed fractures of the humeral shaft treated with ante-grade closed Rush nails at our institute. Patients with preoperative radial nerve injury were excluded from this study. In 186 patients we achieved close to anatomic reduction of the fracture fragments. In 14 patients we had to resort to limited open reduction. Results : Fracture united in 186 of 188 patient followed up for one year. Complications occurred in 26 patients. We strongly advise a careful surgical technique and modification as per the individual fracture pattern to reduce the complications. Conclusion : Osteosynthesis with multiple Rush nails features the advantages of rotational stability of the head-neck fragment to the diaphysis, an unreamed implantation technique without any special instruments, the speed of execution and minimal economic burden so important for the developing country like ours.
Interlocking nailing of humeral shaft fractures a retrospective study of 114 patients  [cached]
Demirel M,Turhan E,Dereboy F,Ozturk A
Indian Journal of Medical Sciences , 2005,
Abstract: Background: Fractures of the humeral shaft are relatively common injuries. Literature suggests that humeral shaft fractures represent approximately 3 % of all fractures. There are several modalities for the management of diaphyseal humeral fractures. The latest investigations emphasize the concept of minimal exposure and rigid fixation. Aim: The aim of the study is to evaluate the results of antegrade intramedullary nailing in humeral shaft fractures. Design: A retrospective review Settings: Patients were treated in private hospital settings by 3 orthopaedics surgeon Material and Methods: Between 1995 and 2003, the technique of antegrade locked intramedullary nailing with UHN in humeral shaft fractures was performed on 114 patients. Forty-two (36%) patients sustained multiple traumas, and 22 (19%) fractures were open. The outcomes were evaluated with a mean follow-up of 41 months. Statistical analysis used: Ranges of results given Results:0 In 109 fractures primary union observed. In the other five patients union achieved after removal of the nail and fixation with DCP and bone grafting. The average time for union was 13 weeks (range, 10-36 weeks). One hundred-five patients had excellent or satisfactory recovery of shoulder and elbow function. Complications included impingement due to proximal locking screws in two patients and prominent nail in three patients, transient postoperative radial nerve palsy in four patients. Conclusions: This study shows that antegrade locked nailing in humeral shaft fractures are reliable and also effective in multiply injured patients.
Humeral Shaft Fracture Treatment in the Elite Throwing Athlete: A Unique Application of Flexible Intramedullary Nailing  [PDF]
Christopher S. Lee,Shane M. Davis,Hoang-Anh Ho,Jan Fronek
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/546804
Abstract: Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. Currently described techniques such as open reduction and internal fixation with plate osteosynthesis and rigid antegrade/retrograde locked intramedullary nailing have significant morbidity due to soft tissue dissection and damage. We present a case report of a high-level baseball pitcher whose significantly displaced humeral shaft stress fracture failed to be nonoperatively managed and was subsequently treated successfully with unlocked, retrograde flexible intramedullary nailing. The athlete was able to return to pitching baseball in one year and is currently pitching in Major League Baseball. We were able to recently collect 10-year follow-up data. 1. Introduction Humeral shaft stress fractures are rare but well-described injuries in throwing athletes [1–9]. Baseball players are particularly at risk of this injury because of their throwing mechanics. Pitchers experience a mean humeral axial torque of almost 90?Nm during maximal external rotation of the shoulder. In addition to axial torque, there is also significant valgus stress to the humerus. This leads to repetitive stress of the humeral shaft as the distal end externally rotates relative to the proximal end [9]. Consequently, stress fractures may progress to displaced spiral fractures of the humeral shaft at the junction of the middle and distal thirds. With baseball becoming an increasingly global and year-round sport, the incidence of humeral shaft stress fractures is likely rising. While minimally displaced fractures heal uneventfully, significantly displaced or angulated fractures present a surgical dilemma. We present a case report where unlocked, retrograde flexible intramedullary nailing was used in a 17-year-old Major League Baseball pitching prospect after failed nonoperative treatment of a humeral shaft stress fracture. To avoid the associated morbidity of plate osteosynthesis and rigid intramedullary nailing, closed reduction and unlocked flexible intramedullary nailing was implemented. This technique has been described in the pediatric population and in select adult cases, but to our knowledge and after a literature review this is the first report of its usage in an adolescent, professional pitching prospect [10]. The patient
The Posteroanterior Locking for the Distal Humerus Nailing. Is It a Viable Option?  [PDF]
Yogesh Salphale, Jagannath Kaginalkar, Wasudeo Mahadeo Gadegone, Kiran Janwe
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.811054
Abstract: The distal interlocking is regarded as an inherent part of the antegrade humeral nailing technique. Traditionally the distal locking of intramedullary humeral nails is achieved using a freehand technique. The humerus nailing locking options in the conventional nailing systems are placed in the anterior-posterior and lateral-medial directions. It exposes both the patient and surgeon to radiation, is time consuming, and has a potential risk of damaging neurovascular structures, especially the radial and lateral cutaneous nerve when the anterior-posterior and lateral-medial locking constructs are used. We aim to present a technical tip to ease the distal locking procedure and avoid the possible neurovascular complications with the existing nailing systems.
Risk Assessment of Retrograde Intramedullary Nailing for Proximal Humeral Fracture  [PDF]
Rina Sakai, Uchino Masataka, Kazuhiro Yoshida, Masanobu Ujihira
Journal of Biomedical Science and Engineering (JBiSE) , 2019, DOI: 10.4236/jbise.2019.125020
Abstract: In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing.
Retrograde interlocking nailing in diaphyseal fractures of humerus  [cached]
Goyal R,Chandra Harish,Pruthi K,Kumar A
Indian Journal of Orthopaedics , 2006,
Abstract: Background : Retrograde interlocking nailing for humeral fracture is technically difficult but has advantage of sparing the involvement of rotator cuff and subacromial bursa. Methods : A total number of 12 cases (9 closed, 3 compound - Grade I and II), having diaphyseal fractures of upper (3 cases) and middle third (9 cases ) of humures were treated by retrograde interlocking nailing. Out of 12 cases, 11 were fresh and 1 was old fractures. Cases were followed up for 3 year. Results : Excellent results were seen in 8, good in 3 and fair in one case ( delayed union). One case developed elbow stiffness, whereas none developed shoulder stiffness. Conclusions : Apart from the overall advantages of conventional locked nailing technique, retrograde locked nailing has additional advantage of sparing the rotator cuff and subacromial bursa, thus prerserving the shoulder functions.
Screw Intramedullary Nailing for Fractures of the Humeral Shaft  [PDF]
Y. S. Salphale, W. M. Gadegone, R. M. Chandak, Jayeshkumar Dave
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.68057
Abstract: The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedullary nails and achieve union with least trauma to the shoulder and the rotator cuff. The multiple elastic screw nails achieve the inherent stability based on the principle of “three point fixation”. We aim to propose that the screw intramedullary nail is an effective implant to facilitate uneventful fracture union, with rapid recovery, low morbidity and low learning curve capable of being replicated in any smaller operative set up.
Multiple flexible intramedullary nailing for the treatment of humeral bone cysts
Guity M,Saberi S,Moetamedi M
Tehran University Medical Journal , 2007,
Abstract: Background: Simple bone cyst is a common benign lesion in the proximal humerus, especially in prepubertal children. Up to 75 percent of patients with the bone cyst have a pathologic fracture and the most significant complication is recurrent pathologic fracture. Since the process of spontaneous healing of these fractures is rare, treatment is required. Ideal treatment for simple bone cyst should stabilize pathologic fractures, assist healing and provide a quick return to normal activity with reduced complication and recurrence. Methods: In this descriptive case series study, 24 patients with simple bone cysts of the humerus were selected for retrograde flexible intramedullary nailing from the lateral cortex of the distal humerus, since 2000 to 2005 at Imam Khomeini Hospital, Tehran. The mean age of the patients was 14.4 years, ranging from 6-39 years. Results were evaluated by plain radiography using the classification system of Capanna et al. Results: The mean duration of follow up for 23 of the patients was 31 (9-51) months. One patient with short-term of follow-up was excluded. Of these patients, 91.3% were healed either completely (65.2%) or with residual minor defect (26.1%). Only one cyst (4.3%) persisted with no response to treatment and one patient (4.3%) had a recurrence of the cyst. However, there was no instance of recurrent pathologic fracture among these patients. Conclusion: This study shows that flexible intramedullary nailing is an effective treatment for humeral simple bone cysts that reduces the chance of complication, recurrence of cyst or pathologic fracture. This technique provides sufficient stability for quick return to normal activity.
Axial projection of the humerus. Proposing a new intraoperative radiological projection in the treatment of proximal humeral fractures by intramedullary nailing  [cached]
Panella A,Notarnicola A,Caiaffa V,Maccagnano G
Prevention and Research : International Open Access Journal of Prevention and Research in Medicine , 2012, DOI: 10.7362/2240-2594.019.2012
Abstract: Background: To guarantee optimal stabilization of proximal humeral fractures treated by intramedullary nailing, it is essential to position the nail correctly in the humeral head, with the proximal screws reaching pluriaxially into the epiphyseal cortices without protruding into the joint. Objectives: Conventional intraoperative fluoroscopic radiography is used to verify the positioning of these parts from the antero-posterior and trans-thoracic views. Methods: We suggest that these projections should be integrated with an axial view, modified with regard to those proposed by Bool-Obata or Velpeau. Results: We verify it is able to check the correct positioning of the head screws while safeguarding higher bone density areas. Conclusions: After an adequate learning curve, this projection could actually replace the trans-thoracic projection, since it serves to study the relations of the screws with the cortex and any protrusion into the joint.
Rotator Cuff Reconstruction and Humeral Head Replacement Using Smaller Humeral Prostheses in Cuff Tear Arthropathy Patients under 70 Years of Age  [PDF]
Naoki Miyoshi, Naoki Suenaga, Naomi Oizumi, Noboru Taniguchi, Hiroshi Ito
Open Journal of Orthopedics (OJO) , 2014, DOI: 10.4236/ojo.2014.410043
Abstract: Background: Most reverse shoulder arthroplasty (RSA) studies have shown good improvement in arm elevation without improvements in external rotation (ER). In addition, high rates of complications after long-term RSA have been reported, suggesting that RSA should be limited to elderly patients, especially those who are older than 70 years old. Since 2001, we have developed a strategy of rotator cuff reconstruction with muscle transfer and humeral head replacement (HHR), using smaller humeral prostheses, in cuff tear arthropathy patients. The aim of the present study was to investigate the clinical outcome of our strategy in patients under 70 years of age who had irreparable rotator cuff tears and osteoarthritis. Materials and Methods: A total of 25 shoulders of 25 patients under 70 years of age (males, 15; females, 10) with irreparable cuff tears were treated with HHR and cuff reconstruction. The average age at the time of surgery was 64.3 years (range, 55 - 69) and the average follow-up period was 38.7 months (range, 24 - 72). The cuff defect was repaired using a partial subscapularis transfer in 14 shoulders; nine shoulders required a latissimus dorsi transfer, one required a pectoralis major transfer, and one required both a latissimus dorsi and a pectoralis major transfer. Clinical outcomes were assessed with the range of motion (ROM), UCLA score, Japanese Orthopaedic Association (JOA) score and postsurgical complications. Results: Shoulder pain was diminished in all patients after surgery. The preoperative UCLA and JOA scores were 13.1 and 47.0 respectively, improving to 28.6 and 81.5 respectively after surgery. Active forward flexion has improved from an average of 89.0° to 138.8°, and the ER improved from an average of 16.2° to 33.2°. No complications occurred after surgery. Conclusion: Anatomical reconstruction using smaller head humeral prostheses yielded favorable results and less complication, compared with RSA. Considering another advantage of ability to retain glenoid bone stock, the current procedure can be a useful option for irreparable rotator cuff tears with OA in patients under 70 years old.
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