Functional outcome of antegrade interlocking intramedullary nailing for humeral shaft fractures
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20174147Keywords:
Closed reamed interlocking nail, Humeral shaft fractures, AntegradeAbstract
Background: Humeral shaft fractures which account for approximately 1-3% of all fractures and 20% of humeral fractures have potential to cause significant disability in the young which is often temporary and in the old often permanent disability. The use of locked intramedullary nailing for the treatment of humeral shaft fractures is gaining popularity because of its biomechanical and biological advantages.
Methods: We present a descriptive retrospective review of 20 consecutive patients with acute humeral shaft fractures treated using an antegrade interlocking nail. Fracture union, functional outcome measured with Constant–Murley shoulder score and American shoulder and elbow surgeons (ASES) shoulder score and complications were assessed.
Results: Patient age ranged from 20 to 74 years (average, 36 years) and average follow-up was 30.7 months (range, 12–48 months). There were 13 male patients and 7 female patients. Fracture of the middle third was most common accounting to 80% (16/20) of the fractures. Fracture union was achieved in 90% (18/20) of our cases. 2 patients had nonunion for which secondary surgeries were needed. According to Constant–Murley score, shoulder function was excellent in 70% (14/20) and good in 25% (5/20). Average ASES score was 93.3%. None of the patients had radial nerve palsy postoperatively.
Conclusions: Gentle progressive reaming, correct entry point, minimal damage to rotator cuff, properly embedding the tip of the nail, good apposition of fracture fragments, static locking will help make antegrade intramedullary nailing, a dependable solution for the treatment of humeral shaft fractures and in achieving successful union with preserved/good shoulder and elbow function.
References
Spiguel AR, Steffner RJ. Humeral shaft fractures. Curr Rev Musculoskelet Med. 2012;5(3):177-83.
Rommens PM, Kuechle R, Bord T, Lewens T, Engelmann R, Blum J. Humeral nailing revisited. Injury. 2008;39:1319–28.
Farragos AF, Schemitsch EH, McKee MD. Complications of intramedullary nailing for fractures of the humeral shaft: a review. J Orthop Trauma. 1999;13:258–67.
Lin J, Shen PW, Hou SM. Complications of locked nailing in humeral shaft fractures. J Trauma. 2003;54(5):943–9.
Baltov A, Mihail R, Dian E. Complications after interlocking intramedullary nailing of humeral shaft fractures. Injury. 2014;45(Suppl 1):S9-15.
Crates J, Whittle AP. Antegrade interlocking nail of acute humeral shaft fractures. Clin Orthop Relat Res. 1998;350:40–50.
Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am. 1977;59(5):596-601.
Westrick E, Hamilton B, Toogood P, Henley B, Firoozabadi R. Humeral shaft fractures: results of operative and non-operative treatment. Int Orthop. 2017;41(2):385-95.
Kulkarni SG, Varshneya A, Jain M, Kulkarni VS, Kulkarni GS, Kulkarni MG, et al. Antegrade interlocking nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg. 2012;20(3):288–91.
Cole PA, Wijdicks CA. The operative treatment of diaphyseal humeral shaft fractures. Hand Clin. 2007; 23(4):437-48.
Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ. Management of humeral shaft fractures. J Am Acad Orthop Surg. 2012;20(7):423–33.
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.
Fan Y, Li Y, Zhang H, Liu J, Han X, Chang X, et al. Management of Humeral Shaft Fractures with Intramedullary Interlocking Nail Versus Locking Compression Plate. Orthopedics. 2015;38:825-9.
Kumar R, Singh P, Chaudhary LJ, Singh S. Humeral shaft fracture management, a prospective study; nailing or plating. J ClinOrthop Trauma. 2012;3(1):37-42.
Wali MGR, 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 Reconstr. 2014;9(3):133-40.
McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br. 2000;82:336–9.
Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop. 2007;31:391–5.
Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000;14:162–6.
Flinkkilä T, Hyvönen P, Siira P, Hämäläinen M. Recovery of shoulder joint function after humeral shaft fracture: A comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg. 2004;124:537–41.
Raghavendra S, Bhalodiya HP. Internal fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: a prospective study. Indian J Orthop. 2007;41:214–8.
Verdano MA, Pellegrini A, Schiavi P, Somenzi L, Concari G, Ceccarelli F. Humeral shaft fractures treated with antegrade intramedullary nailing: What are the consequences for the rotator cuff? Int Orthop. 2013;37(10):2001-7.
Tsourvakas S, Alexandropoulos C, Papachristos I, Tsakoumis G, Ameridis N. Treatment of humeral shaft fractures with antegrade intramedullary locking nail. Musculoskelet Surg. 2011;95(3):193-8.
Petsatodes G, Karataglis D, Papadopoulos P. Christoforides J, Gigis J, PournarasJ. Antegrade interlocking nailing of humeral shaft fractures. J Orthop Sci. 2004;9:247.
