Successful Embolisation of Postoperative Bleeding after IM Nailing of a Proximal Humerus Fracture

Abstract

Locked intramedullary nailing has become a popular treatment for proximal humeral fractures. It combines the advantages of a stable osteosynthesis allowing for early active rehabilitation and those of a minimal invasive approach. We report on a case of postoperative bleeding at the introduction tract of the distal screw, successfully treated by transcatheter embolization. Since this complication is unusual, knowledge of how to treat it may be beneficial to other patients and physicians.

Key words

Proximal humerus - fracture - intramedullary fixation - complication - endovascular treatment

References

• 1 Barriga A, Valenti Nin J R, Delgado J J. Therapeutic embolisation for postoperative haemorrhage after total arthroplasty of the hip and knee.  J Bone Joint Surg [Br]. 2001;  83 90-92
• 2 Hente R, Kampshoff J, Kinner B. et al . Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate.  Unfallchirurg. 2004;  107 769-782
• 3 Kamineni S, Ankem H, Sanghavi S. Anatomical considerations for percutaneous proximal humeral fracture fixation.  Injury. 2004;  35 1133-1136
• 4 Khodadadyan-Klostermann C, Raschke M, Steenlage E. et al . Intramedullary wiring of proximal humerus fractures. Results of a minimally invasive treatment concept.  Eur J Trauma. 2002;  28 234-241
• 5 Kocialkowski A, Wallace W A. Closed percutaneous K-wire stabilization for displaced fractures of the surgical neck of the humerus.  Injury. 1990;  21 209-212
• 6 Maleux G, Stockx L, Brys P. et al . Iatrogenic pseudoaneurysm in the upper arm: treatment by transcatheter embolisation.  Cardiovasc Intervent Radiology. 2000;  23 140-142
• 7 Mathews J, Lobenhoffer P. Results of intramedullary nailing of unstable proximal humeral fractures in geriatric patients with a new antegrade nail system.  Unfallchirurg. 2004;  107 372-380
• 8 Prince E, Breien K, Fehringer E. The relationship of proximal locking screws to the axillary nerve during antegrade humeral nail insertion of four commercially available implants.  J Orthop Trauma. 2004;  18 585-588
• 9 Rajasekhar C, Ray P S, Bhamra M S. Fixation of proximal humeral fractures with the Polarus nail.  J Shoulder Elbow Surg. 2001;  10 7-10
• 10 Resch H, Hubner C, Schwaiger R. Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head.  Injury. 2001;  32 (Suppl 1) SA 25-SA 32
• 11 Resch H. Humeral head fractures.  Unfallchirurg. 2003;  106 602-617
• 12 Seppanen S K, Leppanen M J, Pimenoff G, Seppanen J M. Microcatheter embolization of hemorrhages.  Cardiovasc Intervent Radiol. 1997;  20 174-179
• 13 Stock J R, Athanasoulis C A, Harris W H, Waltman A C, Novelline R A, Greenfield A J. Transcatheter embolization for the control of wound hemorrhage following hip surgery.  J Bone Joint Surg [Am]. 1980;  62 1000-1003