The use of the Neviaser portal for antegrade intramedullary nailing in humerus fractures: a scoping review.

Abstract

Purpose: Proximal humerus and humeral shaft fractures are common orthopaedic injuries that can be managed using antegrade intramedullary nailing. The Neviaser portal allows a more medial start point at the apex of the humeral head. The published literature on humeral intramedullary nailing through the Neviaser portal is limited and heterogeneous. This scoping review aims to map the existing literature on the use of the Neviaser portal for antegrade intramedullary nailing of humeral fractures, summarise reported indications, surgical techniques, radiographic and functional outcomes, complications, and identify gaps in the current evidence.

Methods: Five electronic databases (PubMed, Embase, Scopus, Web of Science, the Cochrane Library) and two grey-literature sources (Google Scholar, ClinicalTrials.gov) were searched. This scoping review was conducted according to the Arksey and O'Malley framework and Joanna Briggs Institute (JBI) guidelines, with reporting in accordance with PRISMA-ScR recommendations.

Results: Ten studies were included. Across the clinical studies, 103 patients underwent nailing through the Neviaser portal, although approach-specific outcomes were reported for fewer patients. Indications for its use included both anatomical factors, such as distorted shoulder anatomy or increased soft tissue bulk, and fracture-related factors, including varus deformity and posterior tilt of the humeral head. One comparative study reported statistically significant differences in functional outcomes, while a second descriptively reported shorter operative time and lower radiation exposure. Both studies were small, non-randomised, and conducted at single centres. Cadaveric studies showed that the Neviaser portal traverses the muscular portion of the supraspinatus while maintaining safe distances from adjacent neurovascular structures, supporting its anatomical feasibility.

Conclusion: Evidence for the Neviaser portal in antegrade intramedullary nailing of humeral fractures remains limited and heterogeneous. Although the available literature supports its anatomical feasibility and potential technical advantages, further high-quality comparative studies are required to define its clinical role.