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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

T4 nail, proximal end and X-ray
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Fig7: T4 nail, proximal end and X-ray

Mentions: Overall, our evaluation of postoperative X-rays revealed a satisfactory reduction, with anatomical recovery of alpha F (44°) and alpha P (36°) angles and greater tuberosity. It should be noted that these results were similar regardless of the type of fracture. In comparison, using the initial Telegraph, Boughrebi et al. [10] found a mean alpha F angle of 38°, and Jayankura et al. [11] found six anatomical or sub-anatomical reductions out of 15 patients with 3- or 4-part Neer fractures. Thus, it seems that the addition of a fourth proximal screw and the polyaxial nature of the proximal locking seem to allow for better stabilization of the greater tuberosity, which offers significant advantages compared with previous versions of the device (Fig. 7). This may result in a satisfactory reduction and a stable osteosynthesis, thereby decreasing the risk of secondary displacement.Fig. 7


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)

T4 nail, proximal end and X-ray
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig7: T4 nail, proximal end and X-ray
Mentions: Overall, our evaluation of postoperative X-rays revealed a satisfactory reduction, with anatomical recovery of alpha F (44°) and alpha P (36°) angles and greater tuberosity. It should be noted that these results were similar regardless of the type of fracture. In comparison, using the initial Telegraph, Boughrebi et al. [10] found a mean alpha F angle of 38°, and Jayankura et al. [11] found six anatomical or sub-anatomical reductions out of 15 patients with 3- or 4-part Neer fractures. Thus, it seems that the addition of a fourth proximal screw and the polyaxial nature of the proximal locking seem to allow for better stabilization of the greater tuberosity, which offers significant advantages compared with previous versions of the device (Fig. 7). This may result in a satisfactory reduction and a stable osteosynthesis, thereby decreasing the risk of secondary displacement.Fig. 7

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