title: Short, locked humeral nailing via Neviaser portal: an anatomic study.
abstract: OBJECTIVE
  Supraspinatus tendon trauma may contribute to residual shoulder pain after nail fixation for proximal humeral fractures. Some have proposed a more medial starting point for humeral nail insertion to avoid cuff tendon footprint damage. We hypothesized that percutaneous nail insertion via Neviaser portal would not only be possible, but would avoid tendon trauma, while sacrificing articular cartilage.
  
  
  METHODS
  Under c-arm guidance and in percutaneous fashion, we nailed 16 consecutive complete (head and neck, etc, intact) specimen right proximal humeri with locked short humeral nails (Aequalis) via Neviaser portal. Each shoulder was dissected to study the damage to the rotator cuff and long head of the biceps tendons as well as to the articular surfaces. We measured the humeral-thoracic abduction arc before the damaged articular surface contacted the superior glenoid. There were 5 male specimens and 11 female specimens with a mean age of 83 years at the time of death.
  
  
  RESULTS
  We successfully inserted 15 of 16 humeral nails through this percutaneous approach. No supraspinatus tendon or long head of the biceps tendon was damaged. All nails passed entirely through supraspinatus muscle belly. Thirteen of 15 starting points were entirely on articular surface. Mean arc of abduction before superior glenoid contact was 76 degrees (range, 50 degrees-130 degrees). Mean distance from the edge of the articular surface to the most lateral part of the nail insertion was 11 mm (0-25 mm).
  
  
  CONCLUSIONS
  Short, locked humeral nail insertion is possible in percutaneous fashion via Neviaser portal without tendon injury. However, successful insertion comes at the cost of articular cartilage damage.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198-1080, USA. aknierim@unmc.edu
authors.forename: Annie E
authors.initials: AE
authors.lastname: Knierim
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Bollinger
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wirth
authors.forename: Edward V
authors.initials: EV
authors.lastname: Fehringer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects; D002102:Cadaver; D002357:Cartilage Diseases / Q000209:etiology; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012784:Shoulder Fractures / Q000601:surgery*; D013708:Tendon Injuries / Q000517:prevention & control / Q000601:surgery