CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2022; 63(03): e205-e214
DOI: 10.1055/s-0042-1744265
Update Article

Current Concepts: Advantages of Intramedullary Nail for Proximal Humerus Fractures

Artikel in mehreren Sprachen: español | English
1   Departamento de Traumatología y Ortopedia, Clínica Universidad de los Andes, Las Condes, Región Metropolitana, Santiago, Chile
› Institutsangaben

Abstract

Proximal humeral fractures are one of the most frequent fractures in the elderly population. Open reduction and internal fixation (ORIF) is generally indicated for young patients and older patients with high functional demands and good bone quality. No consensus has been reached regarding the ideal fixation technique. Although ORIF with plates is the most widely used technique, high re-intervention rates and global complications with locked plate fixation have been reported in the literature. Addition of augmentation techniques to locked plate fixation in complex fractures may result in longer surgical times, extensive approaches, and higher costs. Therefore, considering other options for ORIF is necessary. With a greater understanding of the mechanisms of fixation failure, intramedullary fixation has become the accepted treatment option for proximal humeral fractures considering the specific biomechanical and biological advantages. Compared with ORIF with locked plates, intramedullary fixation for proximal humeral fractures has low surgical time, intraoperative bleeding, time to bone union, and rate of infections. Intramedullary fixation is a valid option to resolve complex fractures with an implant that may largely supply all the augmentation requirements of a locked plate.



Publikationsverlauf

Eingereicht: 16. Juni 2021

Angenommen: 10. Januar 2022

Artikel online veröffentlicht:
06. Juni 2022

© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referencias

  • 1 Passaretti D, Candela V, Sessa P, Gumina S. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg 2017; 26 (12) 2117-2124
  • 2 Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Möller M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. BMC Musculoskelet Disord 2016; 17 (01) 159
  • 3 Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37 (08) 691-697
  • 4 Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 2011; 93 (01) 1-11
  • 5 Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury 2011; 42 (11) 1283-1288
  • 6 Spross C, Zeledon R, Zdravkovic V, Jost B. How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction-internal fixation of proximal humeral fractures. J Shoulder Elbow Surg 2017; 26 (09) 1566-1572
  • 7 Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD. Innovations in the management of displaced proximal humerus fractures. J Am Acad Orthop Surg 2007; 15 (01) 12-26
  • 8 Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res 2005; (430) 176-181
  • 9 Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury 2011; 42 (04) 408-413
  • 10 Jost B, Spross C, Grehn H, Gerber C. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 2013; 22 (04) 542-549
  • 11 Laux CJ, Grubhofer F, Werner CML, Simmen H-P, Osterhoff G. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res 2017; 12 (01) 137
  • 12 Zhang L, Zheng J, Wang W. et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop 2011; 35 (11) 1655-1661
  • 13 Jung W-B, Moon E-S, Kim S-K, Kovacevic D, Kim M-S. Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?. BMC Musculoskelet Disord 2013; 14 (01) 102
  • 14 Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 2007; 21 (03) 185-191
  • 15 Kim H, Shin MJ, Kholinne E. et al. How Many Proximal Screws Are Needed for a Stable Proximal Humerus Fracture Fixation?. Geriatr Orthop Surg Rehabil 2021; 12: 2151459321992744
  • 16 Choi S, Kang H, Bang H. Technical tips: dualplate fixation technique for comminuted proximal humerus fractures. Injury 2014; 45 (08) 1280-1282
  • 17 Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am 2003; 85 (09) 1647-1655
  • 18 Kim SH, Lee YH, Chung SW. et al. Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft. Injury 2012; 43 (10) 1724-1731
  • 19 Egol KA, Sugi MT, Ong CC, Montero N, Davidovitch R, Zuckerman JD. Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Shoulder Elbow Surg 2012; 21 (06) 741-748
  • 20 Euler SA, Hengg C, Wambacher M, Spiegl UJ, Kralinger F. Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population. Arch Orthop Trauma Surg 2015; 135 (01) 79-87
  • 21 Schliemann B, Seifert R, Rosslenbroich SB. et al. Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures. J Shoulder Elbow Surg 2015; 24 (12) 1968-1973
  • 22 Unger S, Erhart S, Kralinger F, Blauth M, Schmoelz W. The effect of in situ augmentation on implant anchorage in proximal humeral head fractures. Injury 2012; 43 (10) 1759-1763
  • 23 Siebenbürger G, Helfen T, Biermann N, Haasters F, Böcker W, Ockert B. Screw-tip augmentation versus standard locked plating of displaced proximal humeral fractures: a retrospective comparative cohort study. J Shoulder Elbow Surg 2019; 28 (07) 1326-1333
  • 24 Walch G, Badet R, Nové-Josserand L, Levigne C. Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elbow Surg 1996; 5 (03) 161-168
  • 25 Saltzman BM, Erickson BJ, Harris JD, Gupta AK, Mighell M, Romeo AA. Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures: A Systematic Review and the Authors' Preferred Surgical Technique. Orthop J Sports Med 2016; 4 (07) 2325967116656829
  • 26 Wang H, Rui B, Lu S, Luo C, Chen Y, Chai Y. Locking Plate Use with or without Strut Support for Varus Displaced Proximal Humeral Fractures in Elderly Patients. JBJS Open Access 2019; 4 (03) e0060
  • 27 Lee SH, Han SS, Yoo BM, Kim JW. Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone. Bone Joint J 2019; 101-B (03) 260-265
  • 28 Parada SA, Makani A, Stadecker MJ, Warner JJP. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction. Am J Orthop 2015; 44 (10) 471-475
  • 29 Sears BW, Hatzidakis AM, Johnston PS. Intramedullary Fixation for Proximal Humeral Fractures. J Am Acad Orthop Surg 2020; 28 (09) e374-e383
  • 30 Füchtmeier B, May R, Hente R. et al. Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants. Arch Orthop Trauma Surg 2007; 127 (06) 441-447
  • 31 Kitson J, Booth G, Day R. A biomechanical comparison of locking plate and locking nail implants used for fractures of the proximal humerus. J Shoulder Elbow Surg 2007; 16 (03) 362-366
  • 32 Clavert P, Hatzidakis A, Boileau P. Anatomical and biomechanical evaluation of an intramedullary nail for fractures of proximal humerus fractures based on tuberosity fixation. Clin Biomech (Bristol, Avon) 2016; 32: 108-112
  • 33 Smith CD, Booker SJ, Uppal HS, Kitson J, Bunker TD. Anatomy of the terminal branch of the posterior circumflex humeral artery: relevance to the deltopectoral approach to the shoulder. Bone Joint J 2016; 98-B (10) 1395-1398
  • 34 Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 2004; 13 (04) 427-433
  • 35 Agudelo J, Schürmann M, Stahel P. et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 2007; 21 (10) 676-681
  • 36 Osterhoff G, Hoch A, Wanner GA, Simmen H-P, Werner CML. Calcar comminution as prognostic factor of clinical outcome after locking plate fixation of proximal humeral fractures. Injury 2012; 43 (10) 1651-1656
  • 37 López C, Pérez A, Knierzinger D, Kralinger F. Predictores de fallo temprano en la osteosíntesis con clavo Multilock recto en las fracturas de húmero proximal de dos fragmentos en el adulto mayor. Ortho-Tips. 2019; 15 (02) 80-87
  • 38 Gadea F, Favard L, Boileau P. et al; SOFCOT. Fixation of 4-part fractures of the proximal humerus: Can we identify radiological criteria that support locking plates or IM nailing? Comparative, retrospective study of 107 cases. Orthop Traumatol Surg Res 2016; 102 (08) 963-970
  • 39 Sun Q, Ge W, Li G. et al. Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. Int Orthop 2018; 42 (03) 641-650
  • 40 Li M, Wang Y, Zhang Y, Yang M, Zhang P, Jiang B. Intramedullary nail versus locking plate for treatment of proximal humeral fractures: A meta-analysis based on 1384 individuals. J Int Med Res 2018; 46 (11) 4363-4376
  • 41 Shi X, Liu H, Xing R. et al. Effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture: an update systematic review and meta-analysis. J Orthop Surg Res 2019; 14 (01) 285
  • 42 Hao TD, Huat AWT. Surgical technique and early outcomes of intramedullary nailing of displaced proximal humeral fractures in an Asian population using a contemporary straight nail design. J Orthop Surg (Hong Kong) 2017; 25 (02) 2309499017713934
  • 43 Jaeger M, Frankie WL. Leung. Nailing (straight nail) [Internet]. AO Surgery Reference; 2011. Available from: https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-humerus/extraarticular-2-part-surgical-neck-impaction/nailing-straight-nail