Application of MultiLoc intramedullary nail technique in the treatment of proximal humeral fracture_West China Medical Journal

Authors：

CHEN Wei , XING Fei , DUAN Xin , LIU Ming , CHEN Jialei ,  XIANG Zhou

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XIANG Zhou, Email: xiangzhou15@hotmail.com

Keywords：

Proximal humeral fractures; MultiLoc; Intramedullary nail; Internal fixation; Elderly fractures

DOI：

10.7507/1002-0179.201912139

Video：

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Because of the complexity of proximal humeral fractures, the treatment of proximal humeral fractures has always been a challenge for clinicians. The MultiLoc intramedullary nail is a new type of internal fixation device which has been gradually used in the treatment of proximal humeral fractures in recent years. At present, it is mainly used in the Neer two- and three-part fractures, especially surgical neck fractures. Its flexible design can provide personalized and multi-plane fixation for fracture patients, “screw-in-screw” and medial supporting screw can effectively reduce the axial displacement and varus angle of humeral head, and minimally invasive surgical incision can reduce the injury of rotator cuff. This review focuses on the research status and related evidence of the design, operation, prognosis, and postoperative complications of MultiLoc intramedullary nail, in order to provide a theoretical basis for the application of MultiLoc intramedullary nail in fracture treatment, and enhance clinicians’ understanding of MultiLoc intramedullary nail as a new type of internal fixation device.

Citation： CHEN Wei, XING Fei, DUAN Xin, LIU Ming, CHEN Jialei, XIANG Zhou. Application of MultiLoc intramedullary nail technique in the treatment of proximal humeral fracture. West China Medical Journal, 2020, 35(12): 1535-1539. doi: 10.7507/1002-0179.201912139 Copy

1.	Nho SJ, Brophy RH, Barker JU, et al. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am, 2007, 89(Suppl 3): 44-58.
2.	Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand, 2004, 75(6): 741-745.
3.	Gaebler C, Mcqueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand, 2003, 74(5): 580-585.
4.	Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res, 2006, 442: 87-92.
5.	Robinson CM, Page RS, Hill RM, et al. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am, 2003, 85(7): 1215-1223.
6.	Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am, 2003, 85(9): 1647-1655.
7.	Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am, 2009, 91(6): 1320-1328.
8.	Silverstein MP, Yirenkyi K, Haidukewych G, et al. Analysis of failure with the use of locked plates for stabilization of proximal humerus fractures. Bull Hosp Jt Dis (2013), 2015, 73(3): 185-189.
9.	Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
10.	Sjödén GO, Movin T, Güntner P, et al. Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value. Acta Orthop Scand, 1997, 68(3): 239-242.
11.	Mittlmeier TW, Stedtfeld HW, Ewert A, et al. Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH). J Bone Joint Surg Am, 2003, 85-A(Suppl 4): 136-146.
12.	Koukakis A, Apostolou CD, Taneja T, et al. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res, 2006, 442: 115-120.
13.	Giannoudis PV, Xypnitos FN, Dimitriou R, et al. “Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature”. J Orthop Surg Res, 2012, 7: 39.
14.	Hessmann MH, Nijs S, Mittlmeier T, et al. Internal fixation of fractures of the proximal humerus with the MultiLoc nail. Oper Orthop Traumatol, 2012, 24(4/5): 418-431.
15.	Helfen T, Siebenbürger G, Mayer M, et al. Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®. BMC Musculoskelet Disord, 2016, 17(1): 448.
16.	Sigl M, Dudeck O, Jung J, et al. Multiple stent delivery system Multi-LOC, a new technology for spot-stenting of the femoropopliteal artery - proof of concept study in a preclinical large animal model. Vasa, 2017, 46(6): 446-451.
17.	Rothstock S, Plecko M, Kloub M, et al. Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model. Clin Biomech (Bristol, Avon), 2012, 27(7): 686-691.
18.	Stedtfeld HW, Mittlmeier T. Fixation of proximal humeral fractures with an intramedullary nail: tipps and tricks. Eur J Trauma Emerg Surg, 2007, 33(4): 367-374.
19.	Schiuma D, Plecko M, Kloub M, et al. Influence of peri-implant bone quality on implant stability. Med Eng Phys, 2013, 35(1): 82-87.
20.	Zhang L, Zheng JY, Wang WL, et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop, 2011, 35(11): 1655-1661.
21.	Katthagen JC, Schwarze M, Bauer L, et al. Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?. Orthop Traumatol Surg Res, 2015, 101(4): 431-435.
22.	王维, 杨军, 顾海伦, 等. MultiLoc 髓内钉内固定治疗肱骨近端骨折并肱骨头内翻畸形. 中国骨与关节损伤杂志, 2018, 33(3): 305-306.
23.	Wanzl M, Foehr P, Schreiber U, et al. Biomechanical testing to evaluate the cut-through resistance of intramedullary nails for the proximal humerus. Injury, 2016, 47(Suppl 7): S20-S24.
24.	Hao TD, Huat AW. Surgical technique and early outcomes of intramedullary nailing of displaced proximal humeral fractures in an Asian population using a contemporary straight nail design. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017713934.
25.	张伟, 范建波, 崔志明, 等. MultiLoc 髓内钉与 PHILOS 钢板治疗肱骨近端骨折的早期疗效比较. 中国骨与关节杂志, 2018, 7(11): 811-815.
26.	Kloub M, Holub K, Urban J, et al. Intramedullary nailing of displaced four-part fractures of the proximal humerus. Injury, 2019, 50(11): 1978-1985.
27.	张伟, 逸弘, 崔胜宇, 等. MultiLoc 髓内钉内固定治疗 Neer 二、三部分肱骨近端骨折的疗效分析. 中国骨与关节损伤杂志, 2018, 33(7): 693-696.
28.	吴京亮, 魏志凌, 魏更生, 等. MultiLoc 髓内钉内固定治疗 Neer 二部分肱骨外科颈骨折. 中国骨与关节损伤杂志, 2018, 33(7): 755-756.
29.	张荣平. MultiLoc 髓内钉与锁定钢板治疗老年肱骨近端骨折的早期疗效. 临床医学研究与实践, 2018, 20: 54-56.
30.	Lopiz Y, Garcia-Coiradas J, Garcia-Fernandez C, et al. Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails. J Shoulder Elbow Surg, 2014, 23(3): 369-376.
31.	李一平, 向明, 杨国勇, 等. 内翻型肱骨近端骨折的治疗: 锁定钢板与髓内钉的临床效果. 中国运动医学杂志, 2018, 37(11): 945-950.
32.	吴其鹏, 刘国辉, 夏天, 等. MultiLoc 髓内钉治疗肱骨近端二、三部分骨折. 临床骨科杂志, 2017, 20(2): 251.
33.	赵东升, 郑晓勇, 余清文, 等. MultiLoc 髓内针治疗老年肱骨近端骨折的临床疗效. 实用骨科杂志, 2017, 23(5): 453-455.
34.	邹义源, 向明, 陈杭, 等. Neer 二部分肱骨外科颈骨折微创治疗: Phlios 钢板与 MultiLoc 髓内钉对比. 中国组织工程研究, 2018, 22(19): 2981-2987.
35.	范智荣, 江涛, 洪伟武, 等. MultiLoc 肱骨髓内钉对比 PHILOS 钢板治疗肱骨近端骨折的Meta分析. 中国组织工程研究, 2019, 23(36): 5896-5904.
36.	Chen YN, Chang CW, Lin CW, et al. Numerical investigation of fracture impaction in proximal humeral fracture fixation with locking plate and intramedullary nail. Int Orthop, 2017, 41(7): 1471-1480.
37.	Euler SA, Petri M, Venderley MB, et al. Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”. Int Orthop, 2017, 41(9): 1715-1721.
38.	Solberg BD, Moon CN, Franco DP, et al. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am, 2009, 91(7): 1689-1697.
39.	Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: a retrospective analysis of 82 cases treated with the Philos(®) locking plate. Injury, 2014, 45(Suppl 6): S43-S48.

1. Nho SJ, Brophy RH, Barker JU, et al. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am, 2007, 89(Suppl 3): 44-58.
2. Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand, 2004, 75(6): 741-745.
3. Gaebler C, Mcqueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand, 2003, 74(5): 580-585.
4. Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res, 2006, 442: 87-92.
5. Robinson CM, Page RS, Hill RM, et al. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am, 2003, 85(7): 1215-1223.
6. Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg Am, 2003, 85(9): 1647-1655.
7. Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am, 2009, 91(6): 1320-1328.
8. Silverstein MP, Yirenkyi K, Haidukewych G, et al. Analysis of failure with the use of locked plates for stabilization of proximal humerus fractures. Bull Hosp Jt Dis (2013), 2015, 73(3): 185-189.
9. Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
10. Sjödén GO, Movin T, Güntner P, et al. Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value. Acta Orthop Scand, 1997, 68(3): 239-242.
11. Mittlmeier TW, Stedtfeld HW, Ewert A, et al. Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH). J Bone Joint Surg Am, 2003, 85-A(Suppl 4): 136-146.
12. Koukakis A, Apostolou CD, Taneja T, et al. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res, 2006, 442: 115-120.
13. Giannoudis PV, Xypnitos FN, Dimitriou R, et al. “Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature”. J Orthop Surg Res, 2012, 7: 39.
14. Hessmann MH, Nijs S, Mittlmeier T, et al. Internal fixation of fractures of the proximal humerus with the MultiLoc nail. Oper Orthop Traumatol, 2012, 24(4/5): 418-431.
15. Helfen T, Siebenbürger G, Mayer M, et al. Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®. BMC Musculoskelet Disord, 2016, 17(1): 448.
16. Sigl M, Dudeck O, Jung J, et al. Multiple stent delivery system Multi-LOC, a new technology for spot-stenting of the femoropopliteal artery - proof of concept study in a preclinical large animal model. Vasa, 2017, 46(6): 446-451.
17. Rothstock S, Plecko M, Kloub M, et al. Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model. Clin Biomech (Bristol, Avon), 2012, 27(7): 686-691.
18. Stedtfeld HW, Mittlmeier T. Fixation of proximal humeral fractures with an intramedullary nail: tipps and tricks. Eur J Trauma Emerg Surg, 2007, 33(4): 367-374.
19. Schiuma D, Plecko M, Kloub M, et al. Influence of peri-implant bone quality on implant stability. Med Eng Phys, 2013, 35(1): 82-87.
20. Zhang L, Zheng JY, Wang WL, et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop, 2011, 35(11): 1655-1661.
21. Katthagen JC, Schwarze M, Bauer L, et al. Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?. Orthop Traumatol Surg Res, 2015, 101(4): 431-435.
22. 王维, 杨军, 顾海伦, 等. MultiLoc 髓内钉内固定治疗肱骨近端骨折并肱骨头内翻畸形. 中国骨与关节损伤杂志, 2018, 33(3): 305-306.
23. Wanzl M, Foehr P, Schreiber U, et al. Biomechanical testing to evaluate the cut-through resistance of intramedullary nails for the proximal humerus. Injury, 2016, 47(Suppl 7): S20-S24.
24. Hao TD, Huat AW. Surgical technique and early outcomes of intramedullary nailing of displaced proximal humeral fractures in an Asian population using a contemporary straight nail design. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017713934.
25. 张伟, 范建波, 崔志明, 等. MultiLoc 髓内钉与 PHILOS 钢板治疗肱骨近端骨折的早期疗效比较. 中国骨与关节杂志, 2018, 7(11): 811-815.
26. Kloub M, Holub K, Urban J, et al. Intramedullary nailing of displaced four-part fractures of the proximal humerus. Injury, 2019, 50(11): 1978-1985.
27. 张伟, 逸弘, 崔胜宇, 等. MultiLoc 髓内钉内固定治疗 Neer 二、三部分肱骨近端骨折的疗效分析. 中国骨与关节损伤杂志, 2018, 33(7): 693-696.
28. 吴京亮, 魏志凌, 魏更生, 等. MultiLoc 髓内钉内固定治疗 Neer 二部分肱骨外科颈骨折. 中国骨与关节损伤杂志, 2018, 33(7): 755-756.
29. 张荣平. MultiLoc 髓内钉与锁定钢板治疗老年肱骨近端骨折的早期疗效. 临床医学研究与实践, 2018, 20: 54-56.
30. Lopiz Y, Garcia-Coiradas J, Garcia-Fernandez C, et al. Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails. J Shoulder Elbow Surg, 2014, 23(3): 369-376.
31. 李一平, 向明, 杨国勇, 等. 内翻型肱骨近端骨折的治疗: 锁定钢板与髓内钉的临床效果. 中国运动医学杂志, 2018, 37(11): 945-950.
32. 吴其鹏, 刘国辉, 夏天, 等. MultiLoc 髓内钉治疗肱骨近端二、三部分骨折. 临床骨科杂志, 2017, 20(2): 251.
33. 赵东升, 郑晓勇, 余清文, 等. MultiLoc 髓内针治疗老年肱骨近端骨折的临床疗效. 实用骨科杂志, 2017, 23(5): 453-455.
34. 邹义源, 向明, 陈杭, 等. Neer 二部分肱骨外科颈骨折微创治疗: Phlios 钢板与 MultiLoc 髓内钉对比. 中国组织工程研究, 2018, 22(19): 2981-2987.
35. 范智荣, 江涛, 洪伟武, 等. MultiLoc 肱骨髓内钉对比 PHILOS 钢板治疗肱骨近端骨折的Meta分析. 中国组织工程研究, 2019, 23(36): 5896-5904.
36. Chen YN, Chang CW, Lin CW, et al. Numerical investigation of fracture impaction in proximal humeral fracture fixation with locking plate and intramedullary nail. Int Orthop, 2017, 41(7): 1471-1480.
37. Euler SA, Petri M, Venderley MB, et al. Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”. Int Orthop, 2017, 41(9): 1715-1721.
38. Solberg BD, Moon CN, Franco DP, et al. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am, 2009, 91(7): 1689-1697.
39. Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: a retrospective analysis of 82 cases treated with the Philos(®) locking plate. Injury, 2014, 45(Suppl 6): S43-S48.

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