Limits...
Antegrade nailing evolution for proximal humeral fractures, the Telegraph IV(®): a study of 67 patients.

Cuny C, Goetzmann T, Dedome D, Gross JB, Irrazi M, Berrichi A, Mayer J, Le Coadou PY, Precup S, Galois L, Mainard D - Eur J Orthop Surg Traumatol (2014)

Bottom Line: The primary outcome measure was the clinical Constant score.Notably, the complication rate was 67% for this latter group.This procedure does not appear suitable for displaced articular fracture for which arthroplasty may be indicated by elderly.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, Metz Mercy Regional Hospital, CHR Metz Mercy, CS45001, 57085, Metz Cedex 03, France, c.cuny@chr-metz-thionville.fr.

ABSTRACT

Introduction: There are multiple surgical treatment methods for proximal humerus fractures (PHF), but rarely do they provide satisfactory results. The objective of this study was to assess radioclinical outcomes and complications in patients treated using a modern intramedullary nailing system the Telegraph I(®).

Materials and methods: This is an observational multicenter study cohort conducted between March 2008 and December 2009 on 105 patients admitted with a diagnosis of PHF and operated on two trauma I centers. The Neer and Articular Surgical neck Tuberosities classifications were used for the study. The primary outcome measure was the clinical Constant score. Follow-up of the patients was done at 6 weeks, 3 months, 6 months, 1 year, and 3 years after the procedure.

Results: A total of 67 patients (51 women and 16 men) were assessed at a mean of 38 months. The weighted Constant score was 88%. The mean rate of complications was 16%. The weighted Constant scores were 84 and 95% for the 2- and 3-part groups, respectively. Articular 4-part fractures had an average score of 86% when they were valgus impacted and 67% for complex disengaged fractures. Notably, the complication rate was 67% for this latter group.

Conclusions: Our clinical results support the use of this antegrade nailing for extra-articular and valgus-impacted articular fractures. This procedure does not appear suitable for displaced articular fracture for which arthroplasty may be indicated by elderly.

Show MeSH

Related in: MedlinePlus

Crucifixion technique in which the head is fixed on the glenoid with a K-wire after reduction
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4300429&req=5

Fig1: Crucifixion technique in which the head is fixed on the glenoid with a K-wire after reduction

Mentions: The average time from injury to surgery was 2 days (0–26 days). Patients were placed in a beach chair position with the shoulder protruding from the table and the arm extended. The image intensifier was placed perpendicular to the arm’s axis. Percutaneous access (PC) in front of the acromion was carried out in 56 cases (53 %), whereas the remaining patients underwent anterolateral (AL) access. In all cases, the cephalic entry point of the Telegraph 4 nail was performed at the top of the humeral head, in an area of joint cartilage, through the muscular section of the rotator cuff. Bone sutures were used in 19 cases (18 %), and the crucifixion (Fig. 1) technique employed in 22 cases (21 %) to ensure the best possible reduction in the fracture (Table 2). The assembly was quick for all patients. Notably, the crucifixion (Fig. 1) consisted of raising the humeral head with a spatula until the anatomical reduction could be temporarily stabilized by a K-wire between the head (i.e., the posterior part in order to avoid contact when the nail goes down) and the glenoid. The tuberosities, which were reduced with a hook or forceps, were stably attached to the nail using screws or bone sutures.Fig. 1


Antegrade nailing evolution for proximal humeral fractures, the Telegraph IV(®): a study of 67 patients.

Cuny C, Goetzmann T, Dedome D, Gross JB, Irrazi M, Berrichi A, Mayer J, Le Coadou PY, Precup S, Galois L, Mainard D - Eur J Orthop Surg Traumatol (2014)

Crucifixion technique in which the head is fixed on the glenoid with a K-wire after reduction
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300429&req=5

Fig1: Crucifixion technique in which the head is fixed on the glenoid with a K-wire after reduction
Mentions: The average time from injury to surgery was 2 days (0–26 days). Patients were placed in a beach chair position with the shoulder protruding from the table and the arm extended. The image intensifier was placed perpendicular to the arm’s axis. Percutaneous access (PC) in front of the acromion was carried out in 56 cases (53 %), whereas the remaining patients underwent anterolateral (AL) access. In all cases, the cephalic entry point of the Telegraph 4 nail was performed at the top of the humeral head, in an area of joint cartilage, through the muscular section of the rotator cuff. Bone sutures were used in 19 cases (18 %), and the crucifixion (Fig. 1) technique employed in 22 cases (21 %) to ensure the best possible reduction in the fracture (Table 2). The assembly was quick for all patients. Notably, the crucifixion (Fig. 1) consisted of raising the humeral head with a spatula until the anatomical reduction could be temporarily stabilized by a K-wire between the head (i.e., the posterior part in order to avoid contact when the nail goes down) and the glenoid. The tuberosities, which were reduced with a hook or forceps, were stably attached to the nail using screws or bone sutures.Fig. 1

Bottom Line: The primary outcome measure was the clinical Constant score.Notably, the complication rate was 67% for this latter group.This procedure does not appear suitable for displaced articular fracture for which arthroplasty may be indicated by elderly.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, Metz Mercy Regional Hospital, CHR Metz Mercy, CS45001, 57085, Metz Cedex 03, France, c.cuny@chr-metz-thionville.fr.

ABSTRACT

Introduction: There are multiple surgical treatment methods for proximal humerus fractures (PHF), but rarely do they provide satisfactory results. The objective of this study was to assess radioclinical outcomes and complications in patients treated using a modern intramedullary nailing system the Telegraph I(®).

Materials and methods: This is an observational multicenter study cohort conducted between March 2008 and December 2009 on 105 patients admitted with a diagnosis of PHF and operated on two trauma I centers. The Neer and Articular Surgical neck Tuberosities classifications were used for the study. The primary outcome measure was the clinical Constant score. Follow-up of the patients was done at 6 weeks, 3 months, 6 months, 1 year, and 3 years after the procedure.

Results: A total of 67 patients (51 women and 16 men) were assessed at a mean of 38 months. The weighted Constant score was 88%. The mean rate of complications was 16%. The weighted Constant scores were 84 and 95% for the 2- and 3-part groups, respectively. Articular 4-part fractures had an average score of 86% when they were valgus impacted and 67% for complex disengaged fractures. Notably, the complication rate was 67% for this latter group.

Conclusions: Our clinical results support the use of this antegrade nailing for extra-articular and valgus-impacted articular fractures. This procedure does not appear suitable for displaced articular fracture for which arthroplasty may be indicated by elderly.

Show MeSH
Related in: MedlinePlus