2006 - UZ Leuven

patients of 70 years and older treated in our department between1978 and 1983 with 1102 patients treated between 1998 and 2003.Both groups had a prospective follow-up of at least one year. Therewere no statistically significant differences: mortality rate 24% vs.23%; good functional outcome 82% vs. 73%; and home going rate60% vs. 66%. The factors influencing these results were studied. Sowe can conclude: - the number of hip fractures treated nowadaysincreased compared with twenty years ago; - there is no significantimprovement in mortality, nor in quality of life; - age is not acontraindication for hip fracture surgery.JOCHMANS I., NIJS S., DE BONNAIRE G., SERMON A., BROOS P.: Howsafe is proximal humeral nailing? Eur. J. Trauma, 2006; 32: 580(Abstract).Introduction: Proximal humeral fractures are frequently treated usingantegrade nailing. To secure the head fragment multiple locking boltsor spiral blades are used. Little evidence is available about the safetyof proximal humeral nailing. Theoretically these locking bolts canendanger several structures around the shoulder, among others: theaxillary nerve, the long head of the biceps tendon, the anteriorcircumflex humeral artery and its ascending branch.Materials and methods: We did implant the Synthes PHN and C-PHN,the Strycker T2-PHN, the Smith & Nephew Trigen PHN, the Braun-Aesculap Targon nail and the Zimmer Sirus nail in 30 cadavers. Usinga digital calippometer the distance between the locking bolts and theabove-mentioned structures has been recorded. Each measurementhas been repeated 3 times to minimize measurement errors.Furthermore the distance between the acromions lateral edge and theaxillary nerve has been recorded dorsally and ventrally as the width ofthe axillary nerve in order to be able to describe the variability of thecourse of the axillary nerve and to comparative plot the results of thedifferent implantations.Results: There was wide variability in distance of the bolts to both tothe axillary nerve and the ascending branch of the anterior circumflexhumeral artery. The mean minimal distance between a bolt an theaxillary nerve was 6,85 mm. However this distance is very variablebetween the different nail types ranging from a mean of 13,5 mm forthe Targon nail to 1 mm for the Sirus nail. The mean distance betweenthe antero-posterior locking screw in the three nail types offering thislocking possibility and the ascending arterial branch is 7,3 mm.Conclusion: Proximal humeral nailing is a widespread technique.However the safety both regarding the axillary nerve as the ascendingbranch of the anterior circumflex humeral artery is limited. There is awide variability in safety between the different nail designs. As121