DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20211388

A prospective randomised control study on dynamic compression plating versus intra medullary interlocking nailing in humeral diaphyseal fractures

Muhammed Junaid Abdul, Jojin Jose Chitten, Ramasamy Balasubramaniam, Rajamohan Rajesh

Abstract


Background: Surgical fixation of humeral shaft fractures generally involves plating or nailing. Despite the extensive literature comparing outcomes after open reduction with internal fixation (ORIF) with plating and interlocking intramedullary nailing (ILIMN) for acute humeral diaphyseal fractures, the superior treatment strategy still remains controversial. The purpose of this study was to compare the functional outcome of each method of fixation (dynamic compression plating and interlocking nailing) for the shaft of humerus fracture and to analyse statistically significant difference in the results of these two methods in terms of functional outcome, rate of healing and complications.

Methods: We conducted a prospective randomized control study and evaluated the results of 50 patients having humeral shaft fracture which were internally fixed with antegrade interlocking nailing (25 patients) and dynamic compression plating (DCP) plate (25 patients). Patients were followed up on average of 11.4 months and their radiological outcomes were assessed with plain radiography and with DASH score.

Results: The plating group had statistically significant faster radiological healing and better DASH score compared to nailing group. Also, postoperative complication rate was higher in ILN group which was statistically significant.

Conclusions: ORIF with DCP provides better results in terms of good functional outcome, faster radiological union and less post-operative complications compared to ILIM nailing.  Hence, we concluded that plating is a superior option than nailing.


Keywords


Humerus fracture, Interlocking intramedullary nail, DCP, ORIF, DASH score

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References


Zarkadis NJ, Eisenstein ED, Kusnezov NA, Dunn JC, Blair JA. Open reduction-internal fixation versus intramedullary nailing for humeral shaft fractures: An expected value decision analysis. J Shoulder Elbow Surg. 2018;27(2):204-10.

Gupta P, Jain N. Humerus midshaft fractures-nailing or Plating? A prospective study over 60 patients. J Bone Joint Dis. 2018;33(3):18-21.

Saroj DK, Nagaich A, Gupt P. Comparative study of results of ORIF with plating vs CRIF with nailing in fracture midshaft humerus. Int J Orthop Sci. 2020;6(1):1-4.

Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop. 2010;34(4):571-6.

Wang X, Chen Z, Shao Y, Ma Y, Fu D, Xia Q. A meta-analysis of plate fixation versus intramedullary nailing for humeral shaft fractures. J Orthop Sci. 2013;18(3):388-97.

Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M. Humeral shaft fractures: a review. J Shoulder Elbow Surg. 2011;20(5):833-44.

Modi N, Pundkar GN. Comparative study of functional outcome of dynamic compression plating with intramedullary interlocking nailing in close fracture shaft of humerus in adults. J Res Med Dent Sci. 2015;3(4):298-302.

Cocco LF, Ejnisman B, Belangero PS, Cohen M, Reis FB. Quality of life after antegrade intramedullary nail fixation of humeral fractures: A survey in a selected cohort of Brazilian patients. Pat Safety Surg. 2018;12(1):4.

Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000;14(3):162-6.

Balfour GW, Mooney V, Ashby ME. Diaphyseal fractures of the humerus treated with a ready-made fracture brace. J Bone Joint Surg Am. 1982;64(1):11.

Gottschalk MB, Carpenter W, Hiza E, Reisman W, Roberson J. Humeral shaft fracture fixation:Incidence rates and complications as reported by American board of orthopaedic surgery part II candidates. J Bone Joint Surg Am. 2016;98(17):e71.

Tetsworth K, Hohmann E, Glatt V. Minimally invasive plate osteosynthesis of humeral shaft fractures: current state of the art. J Am Acad Orthop Surg. 2018;26(18):652-6.

Dai J, Chai Y, Wang C, Wen G. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fracture: a meta-analysis of RCTs and nonrandomized studies. J Orthop Sci. 2014;19(2):282-91.

Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg. 2013;22(3):387-95.

Zhao J, Wang J, Wang C, Kan S. Intramedullary nail versus plate fixation for humeral shaft fractures: A systematic review of overlapping meta-analyses. Medicine. 2015;94(11):599.

Wali MG, Baba AN, Latoo IA, Bhat NA, Baba OK, Sharma S. Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail: a prospective, randomised study. Strategies Trauma Limb Recononstr. 2014;9(3):133-40.