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The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Review Article | Vol 12 | Issue 1 | January-June 2026 | page: 15-20 | Sachin Kale, Abhilash Srivastava, Sandeep Deore, Atul Yadav, Kushdeep, Shivesh Datta DOI: https://doi.org/10.13107/ti.2026.v12.i01.78 Submitted: 08/02/2026; Reviewed: 03/03/2026; Accepted: 15/03/2026; Published: 10/04/2026 Authors: Sachin Kale [1], Abhilash Srivastava [1], Sandeep Deore [1], Atul Yadav [1], Kushdeep [1], Shivesh Datta [1] [1] […]

Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait?

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Review Article | Vol 12 | Issue 1 | January-June 2026 | page: 12-14 | Prannoy Paul, Sujit Jos, Shalini Miriam Ipe, Ashna Manoj, Muhammad Ebadur Rahman Siddiqui DOI: https://doi.org/10.13107/ti.2026.v12.i01.76 Submitted: 11/01/2026; Reviewed: 10/01/2026; Accepted: 26/03/2026; Published: 10/04/2026 Authors: Prannoy Paul [1], Sujit Jos [1], Shalini Miriam Ipe [2], Ashna Manoj [3], Muhammad Ebadur Rahman […]

The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait?

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

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The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

DOI: https://doi.org/10.13107/ti.2026.v12.i01.78

Submitted: 08/02/2026; Reviewed: 03/03/2026; Accepted: 15/03/2026; Published: 10/04/2026

Authors: Sachin Kale [1], Abhilash Srivastava [1], Sandeep Deore [1], Atul Yadav [1], Kushdeep [1], Shivesh Datta [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Abhilash Srivastava,

Assistant Professor, Department of Orthopaedics Dr. D.Y. Patil Medical College, Nerul, Navi Mumbai – 400706, India

Email: charlie.srivastava009@gmail.com

Abstract

Introduction: Humerus shaft fractures constitute a significant proportion of long bone fractures, presenting challenges in treatment. While plate osteosynthesis and intramedullary nailing are common fixation modalities, traditional approaches often carry substantial risks, including extensive surgical exposure, rotator cuff violation, and neurovascular injury. This article details the three-stitch technique for antegrade humerus nailing, a minimally invasive approach designed to mitigate these perioperative and postoperative complications, particularly for comminuted shaft humerus fractures.

Methodology: This report synthesises findings from two prospective studies conducted at Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mumbai. The first study (May 2016-May 2018) involved 20 adult patients with diaphyseal humeral shaft fractures. The second study (March 2022-March 2024) included 24 adult patients with posttraumatic comminuted humerus shaft fractures, classified up to type 12C according to AO/OTA. Both studies employed the three-stitch technique for closed antegrade intramedullary interlocking nailing. The surgical technique involved positioning patients in a “beach chair” position, using small stab incisions (approximately 1 cm) for the entry portal (anterior to the anterior rim of the acromion to preserve the rotator cuff), and for proximal and distal locking. Meticulous, blunt soft tissue dissection with a K-wire and the use of soft tissue protection sleeves were critical steps to protect neurovascular structures during drilling and screw insertion, particularly for the antero-posterior distal locking. Patients underwent early mobilisation and were followed up for functional outcomes.

Results: In the initial study of 20 diaphyseal fractures, all patients showed good to excellent results at one year, with a mean union time of 8 weeks, and all fractures united by 10 weeks. Crucially, no complications such as rotator cuff violation, shoulder stiffness, or neurovascular injury were reported. For the 24 patients with comminuted fractures, 22 (96%) exhibited excellent functional outcomes and good adherence to rehabilitation. There were only two instances of delayed wound healing, and importantly, no cases of nonunion were observed. Objective assessments using the Mayo Elbow Performance Index (MEPI) and University of California at Los Angeles (UCLA) scores demonstrated significant restoration of function, with MEPI scores improving from 18 to 23 within the excellent outcome group over 6 months, and UCLA scores enhancing from 20 to 23 (exceptional to good ratings).

Conclusion: The three-stitch technique for antegrade humerus nailing is a viable and advantageous alternative to conventional methods and other surgical techniques like external fixators and plate osteosynthesis, especially for comminuted injuries. It consistently yields favourable outcomes, significantly reduces complications (including rotator cuff violation and neurovascular injury), and improves cosmetic results.

Keywords: Antegrade humerus nailing, three-stitch technique, humerus diaphyseal fractures, MEPI score, UCLA score.

References

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How to Cite this article: Kale S, Srivastava A, Deore S, Yadav A, Kushdeep, Datta S | The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review | January-June 2026; 12(1): 15-20 | https://doi.org/10.13107/ti.2026.v12.i01.78

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Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait?

April 10, 2026/in January-June 2026 | Volume 12 | Issue 1

DOI: https://doi.org/10.13107/ti.2026.v12.i01.76

Submitted: 11/01/2026; Reviewed: 10/01/2026; Accepted: 26/03/2026; Published: 10/04/2026

Authors: Prannoy Paul [1], Sujit Jos [1], Shalini Miriam Ipe [2], Ashna Manoj [3], Muhammad Ebadur Rahman Siddiqui [4]

[1] Institute of Advanced Orthopedics, M.O.S.C Medical College Hospital, Kolenchery, Ernakulam, Kerala, India.
[2] Department of Anesthesia, M.O.S.C Medical College Hospital, Kolenchery, Kerala, India. Ernakulam, Kerala.
[3] Department of Anesthesia, Lakeshore hospital, Kochi, Ernakulam, Kerala, India.
[4] Adamjee Government Science College, Karachi, Pakistan

Address of Correspondence

Dr. Prannoy Paul, Institute of Advanced Orthopedics, M.O.S.C Medical College Hospital, Kolenchery, Ernakulam, Kerala.
Email prannoypaul@gmail.com

Abstract

Hip fractures in the elderly are an orthopedic emergency. Timely surgical intervention—ideally within 24 to 48 hours—has been strongly associated with reduced morbidity, mortality, and length of hospital stay. However, with the increasing prevalence of cardiovascular and cerebrovascular comorbidities, many of these patients present on oral antiplatelet agents or anticoagulants such as clopidogrel, aspirin, warfarin, or newer direct oral anticoagulants (DOACs). The critical question facing orthopedic teams worldwide is whether surgery should be delayed to mitigate bleeding risks or whether early surgery should proceed despite pharmacologic anticoagulation. This article aims to explore the evidence and practical considerations surrounding this dilemma. Keywords: Hip Fracture, Antiplatelet Therapy, Clopidogrel, Surgical Timing, Perioperative Bleeding

References

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How to Cite this article: Paul P, Jos S, Ipe SM, Manoj A | Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait? | January-June 2026; 12(1): 12-14 | https://doi.org/10.13107/ti.2026.v12.i01.76

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review

Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait?

The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review

Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait?

Full Sized Blog Element (Big Preview Pic)

The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review

Authors: Sachin Kale [1], Abhilash Srivastava [1], Sandeep Deore [1], Atul Yadav [1], Kushdeep [1], Shivesh Datta [1]

Abstract

References

(Abstract Text HTML) (Download PDF)

Oral Anticouagulants in Hip Fracture. Is it Actually Worth the Wait?

Authors: Prannoy Paul [1], Sujit Jos [1], Shalini Miriam Ipe [2], Ashna Manoj [3], Muhammad Ebadur Rahman Siddiqui [4]

Abstract

References

(Abstract Text HTML) (Download PDF)

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