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Displaced Two-Part Surgical-Neck Fractures: SURGICAL Classification and Results of Third-generation Percutaneous Intramedullary Nailing

Published in N°278 - November 2018
Article viewed 86 times

Displaced Two-Part Surgical-Neck Fractures: SURGICAL Classification and Results of Third-generation Percutaneous Intramedullary Nailing

By Pascal Boileau, Thomas d'Ollonne, Charles Bessière, Philippe Clavert, Armodios M Hatzidakis, Marc-Olivier Gauci, Mikaël Chelli in category TECHNIQUE

Percutaneous IM nailing, using a third-generation of humeral nail, is a reliable and safe alternative to locking plate fixation for the treatment of displaced 2-part surgical neck fractures. It provides high rate of fracture healing and excellent clinical outcome scores. No morbidity related to the passage of the nail through the supraspinatus muscle and the cartilage was observed. Our results encourage us to pursue our experience.

Introduction

The most commonly used fixation option for two-part surgical neck fractures requiring surgical treatment is a locking plate and screw construct, though many complications have been reported throughout the literature related to this option. 6,11-13,21-23,25,28,30-32,35,40,45,47,49,51-53,56,57

Antegrade intramedullary nailing for surgical neck fractures of the proximal humerus could be an alternative treatment option to locking plates. However, the high rate of complications and reoperations observed with the early designs of first- (unlocked) and second-generation (bent design) intramedullary humeral nails has discouraged their use by most surgeons.1,39,44,48,50

In an effort to overcome these problems, we developed a third-generation humeral IM nail (Aequalis IM Humeral nail, Wright-Tornier, Bloomington, USA). This new generation of humeral IM nail is cannulated, has a low-profile and straight design, and the proximal screws are tuberosity-oriented and locked by polyethylene bushing inside the proximal part of the nail.3,4 In the present study, we report our clinical experience with percutaneous intramedullary nailing, using this third-generation nail.

The aims of the present study are (1) to classify displaced surgical neck fractures to determine the optimal...

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