Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails

Abstract

Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35-110) min; less mean blood loss, 70 (30-170) ml and shorter mean hospital stay, 5.8 (3-12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.

Courses of the Radial Nerve Differ Between Chinese and Caucasians

“…Careful dissection with clear observation from the lateral intermuscular septum [3] from the proximal and distal aspects allows for displacement of the radial nerve and facilitates safe placement of the dynamic compression plate deep to it. Intramedullary nailing and external fixation provide the advantages of preserving soft tissue around the fracture site [3,6,7,18]. Although these techniques often involve closed reduction and percutaneous fixation, iatrogenic injury of the radial nerve still can result from insertion of a blind locking screw or external full or half pin.…”

“…In studies by Chao et al [6] and Chapman et al [7], the anterolateral approach was applied in the upper thirds of the humeral shaft and the posterior approach was used in fractures of the middle and distal thirds of the humerus [1,12,14,20,21]. The danger zone for plate fixation of fractures of the middle to distal thirds of the humerus, especially via the posterior approach, is where the nerve runs along the posterior aspect of the humerus.…”

“…Six-, seven-, and eight-hole broad dynamic compression plates of the AO system (4.5-mm broad compression plate; Smith and Nephew, Memphis, TN) are commonly used to treat humeral shaft fractures [6,7,14,18]; the lengths of these plates are 10.4, 11.9, and 13.5 cm, respectively. Each size of these plates is longer than the course along the posterior humerus.…”

Nailing versus plating in humerus shaft fractures: A prospective comparative study

“…While there are several methods of operative intervention for humerus shaft fractures, the internal fixation methods can be broadly grouped as plating or intramedullary techniques. Interlocking nailing is preferable in communited, segmental and pathological fractures while plating may be the preferred option where radial nerve exploration is contemplated [5,13,14]. Conventional plating techniques involve an extensive surgical approach for open reduction of fracture.…”

Radial nerve palsy following plate osteosynthesis of shaft humerus in relation to posterior verses anterolateral approach

“…Restriction of shoulder movement and delayed union are common complications associated with nailing. [13][14][15] Up to 20% patients complain of shoulder pain due to injury to rotator cuff, protrusion of nail or adhesive capsulitis. 13,16 Similarly secondary radial nerve palsy is a common complication associated although both procedures have benefits and complication Still plate and screw fixation for middle 1/3 rd of shaft humerus remains the gold standard for surgical management as observed by Paris H et al 18 Different approaches for humeral shaft fractures are anterolateral, posterior, postero-lateral and lateral.…”