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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.

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Related in: MedlinePlus

Lateral view
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Fig3: Lateral view

Mentions: Results were assessed using the clinical Constant score (rough and weighted) [7], according to age and gender. Postoperative digital X-rays of the shoulder, which were carried out by the radiology department of each center (frontal and lateral view), were used to determine the quality of reduction. In this regard, the following angles were measured (Figs. 2, 3): alpha F of frontal tilt (looking for a valgus or residual varus on the frontal X-ray, with 45° considered as normal); alpha P of the sagittal tilt of the humeral head on the lateral view (assessing postoperative anterior or posterior tilt, with 30° considered as normal). In addition, the frontal displacement of the greater tuberosity in relation to the lateral edge of the articular surface was recorded by the three resident orthopedic surgeons. Finally, any complications related to these fractures were collected during the follow-up period, especially in cases involving second surgery.Fig. 2


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)

Lateral view
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Lateral view
Mentions: Results were assessed using the clinical Constant score (rough and weighted) [7], according to age and gender. Postoperative digital X-rays of the shoulder, which were carried out by the radiology department of each center (frontal and lateral view), were used to determine the quality of reduction. In this regard, the following angles were measured (Figs. 2, 3): alpha F of frontal tilt (looking for a valgus or residual varus on the frontal X-ray, with 45° considered as normal); alpha P of the sagittal tilt of the humeral head on the lateral view (assessing postoperative anterior or posterior tilt, with 30° considered as normal). In addition, the frontal displacement of the greater tuberosity in relation to the lateral edge of the articular surface was recorded by the three resident orthopedic surgeons. Finally, any complications related to these fractures were collected during the follow-up period, especially in cases involving second surgery.Fig. 2

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