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Article: Differences in soft tissue damage using a percutaneous versus open approach for antegrade straight humeral nailing: a quantitative and qualitative anatomical study

TitleDifferences in soft tissue damage using a percutaneous versus open approach for antegrade straight humeral nailing: a quantitative and qualitative anatomical study
Authors
Keywordscadaver study
percutaneous nailing
proximal humerus fracture
rotator cuff injury
Issue Date2021
PublisherSAGE Publications: Creative Commons. The Journal's web site is located at https://journals.sagepub.com/home/osj
Citation
Journal of Orthopaedic Surgery, 2021, v. 29 n. 2, p. article no. 23094990211010548 How to Cite?
AbstractBackground: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. Materials and Methods: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. Results: The percutaneous technique produced greater latitudinal tearing (p = 0.002) and less longitudinal tearing (p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area (p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. Conclusions: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.
Persistent Identifierhttp://hdl.handle.net/10722/306639
ISSN
2021 Impact Factor: 1.482
2020 SCImago Journal Rankings: 0.457
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFang, C-
dc.contributor.authorYee, DKH-
dc.contributor.authorWong, TM-
dc.contributor.authorFang, E-
dc.contributor.authorPun, T-
dc.contributor.authorLau, TW-
dc.contributor.authorWong, J-
dc.contributor.authorLeung, F-
dc.contributor.authorLiu, R-
dc.contributor.authorCheung, CC-
dc.contributor.authorTipoe, GL-
dc.contributor.authorLeung, F-
dc.date.accessioned2021-10-22T07:37:29Z-
dc.date.available2021-10-22T07:37:29Z-
dc.date.issued2021-
dc.identifier.citationJournal of Orthopaedic Surgery, 2021, v. 29 n. 2, p. article no. 23094990211010548-
dc.identifier.issn1022-5536-
dc.identifier.urihttp://hdl.handle.net/10722/306639-
dc.description.abstractBackground: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. Materials and Methods: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. Results: The percutaneous technique produced greater latitudinal tearing (p = 0.002) and less longitudinal tearing (p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area (p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. Conclusions: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.-
dc.languageeng-
dc.publisherSAGE Publications: Creative Commons. The Journal's web site is located at https://journals.sagepub.com/home/osj-
dc.relation.ispartofJournal of Orthopaedic Surgery-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectcadaver study-
dc.subjectpercutaneous nailing-
dc.subjectproximal humerus fracture-
dc.subjectrotator cuff injury-
dc.titleDifferences in soft tissue damage using a percutaneous versus open approach for antegrade straight humeral nailing: a quantitative and qualitative anatomical study-
dc.typeArticle-
dc.identifier.emailFang, C: cfang@hku.hk-
dc.identifier.emailYee, DKH: yeedns@hku.hk-
dc.identifier.emailWong, TM: wongtm@hku.hk-
dc.identifier.emailPun, T: tpun@hku.hk-
dc.identifier.emailLau, TW: catcher@hkucc.hku.hk-
dc.identifier.emailWong, J: januswong@connect.hku.hk-
dc.identifier.emailLeung, F: feleung@hku.hk-
dc.identifier.emailTipoe, GL: tgeorge@hku.hk-
dc.identifier.emailLeung, F: klleunga@hkucc.hku.hk-
dc.identifier.authorityFang, C=rp02016-
dc.identifier.authorityWong, TM=rp01689-
dc.identifier.authorityPun, T=rp02258-
dc.identifier.authorityWong, J=rp02525-
dc.identifier.authorityTipoe, GL=rp00371-
dc.identifier.authorityLeung, F=rp00297-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1177/23094990211010548-
dc.identifier.pmid34008454-
dc.identifier.scopuseid_2-s2.0-85106147422-
dc.identifier.hkuros328765-
dc.identifier.volume29-
dc.identifier.issue2-
dc.identifier.spagearticle no. 23094990211010548-
dc.identifier.epagearticle no. 23094990211010548-
dc.identifier.isiWOS:000711439700001-
dc.publisher.placeUnited States-

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