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Proximal migration of the Marchetti–Vincenzi flexible humeral nail — a report of two cases
Injury, Int. J. Care Injured 32 (2001) 76 – 77 www.elsevier.com/locate/injury
Case report
Proximal migration of the Marchetti–Vincenzi flexible humeral nail — a report of two cases S. Tennant a,b,*, J.P. Murphy a, P. Warren a a
Department of Orthopaedics, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK b 40C Ashmore Road, Maida Vale, London W 9 3DF, UK Accepted 8 June 2000
1. Introduction The Marchetti–Vincenzi (MV) flexible bundle nail offers potential advantages over conventional locked nails for the stabilisation of humeral shaft fractures. While still providing rotational stability, the system avoids proximal locking with its attendant risks to neurovascular and tendinous structures [1,2]: retrograde insertion, a shorter operation time and decreased exposure to ionising radiation are additional benefits. Although the early experience of the MV humeral nail appears satisfactory [3,4], we report complications which may restrict the indications for this device.
2. Case 1 An 87-year-old woman underwent MV nailing of an oblique mid-shaft humeral fracture. During insertion, one of the prongs penetrated a non-articular portion of the humeral head. Mobilisation using elbow crutches post-operatively was associated with progressive penetration of all five prongs through the humeral head (Fig. 1).
3. Case 2 A 68-year-old woman underwent MV nailing for delayed union of a spiral fracture of the right proximal humeral shaft. Six months later, the pins were noted to be protruding and the fracture did not proceed to union. * Corresponding author.
Fig. 1. Radiograph to show perforation of the proximal humerus in the immediate post-operative period and subsequent further migration 2 weeks later (case 1).
0020-1383/00/$ - see front matter © 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 0 ) 0 0 1 1 9 - 4
S. Tennant et al. / Injury, Int. J. Care Injured 32 (2001) 76–77
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required. Locked nails may be more appropriate.
4. Discussion The use of MV nails in the lower limb may require external support and protected weight-bearing [5]. Humeral intra-medullary nails are not exposed to the same forces, however, Case 1 demonstrates the care that is needed during the insertion of the MV nail to prevent initial perforation of the cortex; Axial load from elbow crutches may have contributed to subsequent further migration of the pins. Case 2 demonstrates that even with normal use of the arm, migration can occur in osteo-porotic bone. Despite its potential advantages, we suggest that the MV nail is not an appropriate fixation device in osteoporotic bone, particularly when walking aids are
References [1] Port AM, Nanu AM, Cross AT. Windows for humeral interlocking nails — an anatomical study. J Bone Jt Surg (Br) 1997;79(Suppl. 1):102. [2] Faruqui NA, Hutchins PM. Humeral nailing — an anatomical study. J Bone Jt Surg (Br) 1997;79(Suppl. 1):102. [3] Chantelot C, Besson A, Feugas C, Elkholti K, Fontaine C, Beltrand E. Treatment of humeral shaft fractures by means of Marchetti nailing. Ann Chir Main Memb Super 1998;17:165–74. [4] Williams PR, Shewring D. Use of an elastic intramedullary nail in difficult humeral fractures. Injury 1998;29(9):661– 70. [5] Hargreaves D, Warren P, Pereira J, Hollingdale J. Complications following the use of the Marchetti flexible intra-medullary nail. Injury 1996;27(10):735– 8.
.
Case report
Proximal migration of the Marchetti–Vincenzi flexible humeral nail — a report of two cases S. Tennant a,b,*, J.P. Murphy a, P. Warren a a
Department of Orthopaedics, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK b 40C Ashmore Road, Maida Vale, London W 9 3DF, UK Accepted 8 June 2000
1. Introduction The Marchetti–Vincenzi (MV) flexible bundle nail offers potential advantages over conventional locked nails for the stabilisation of humeral shaft fractures. While still providing rotational stability, the system avoids proximal locking with its attendant risks to neurovascular and tendinous structures [1,2]: retrograde insertion, a shorter operation time and decreased exposure to ionising radiation are additional benefits. Although the early experience of the MV humeral nail appears satisfactory [3,4], we report complications which may restrict the indications for this device.
2. Case 1 An 87-year-old woman underwent MV nailing of an oblique mid-shaft humeral fracture. During insertion, one of the prongs penetrated a non-articular portion of the humeral head. Mobilisation using elbow crutches post-operatively was associated with progressive penetration of all five prongs through the humeral head (Fig. 1).
3. Case 2 A 68-year-old woman underwent MV nailing for delayed union of a spiral fracture of the right proximal humeral shaft. Six months later, the pins were noted to be protruding and the fracture did not proceed to union. * Corresponding author.
Fig. 1. Radiograph to show perforation of the proximal humerus in the immediate post-operative period and subsequent further migration 2 weeks later (case 1).
0020-1383/00/$ - see front matter © 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 0 ) 0 0 1 1 9 - 4
S. Tennant et al. / Injury, Int. J. Care Injured 32 (2001) 76–77
77
required. Locked nails may be more appropriate.
4. Discussion The use of MV nails in the lower limb may require external support and protected weight-bearing [5]. Humeral intra-medullary nails are not exposed to the same forces, however, Case 1 demonstrates the care that is needed during the insertion of the MV nail to prevent initial perforation of the cortex; Axial load from elbow crutches may have contributed to subsequent further migration of the pins. Case 2 demonstrates that even with normal use of the arm, migration can occur in osteo-porotic bone. Despite its potential advantages, we suggest that the MV nail is not an appropriate fixation device in osteoporotic bone, particularly when walking aids are
References [1] Port AM, Nanu AM, Cross AT. Windows for humeral interlocking nails — an anatomical study. J Bone Jt Surg (Br) 1997;79(Suppl. 1):102. [2] Faruqui NA, Hutchins PM. Humeral nailing — an anatomical study. J Bone Jt Surg (Br) 1997;79(Suppl. 1):102. [3] Chantelot C, Besson A, Feugas C, Elkholti K, Fontaine C, Beltrand E. Treatment of humeral shaft fractures by means of Marchetti nailing. Ann Chir Main Memb Super 1998;17:165–74. [4] Williams PR, Shewring D. Use of an elastic intramedullary nail in difficult humeral fractures. Injury 1998;29(9):661– 70. [5] Hargreaves D, Warren P, Pereira J, Hollingdale J. Complications following the use of the Marchetti flexible intra-medullary nail. Injury 1996;27(10):735– 8.
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