Late Functional Results of Humeral Fractures Treated with the Telescopic Locking Nail®

Abstract

In the treatment of humeral fractures, the standard therapy still is non-operative. However there are generally accepted indications for operative treatment of humeral shaft fractures: polytrauma, open fractures, neurovascular lesions, bilateral humeral fractures, floating elbow, inability to maintain reduction. These indications constitute a negative sample of the humeral fractures and are so called problem fractures. In order to treat these, a stable implant is mandatory. The Telescopic Locking Nail is developed for this kind of fractures. It's a straight nail with a central diameter of 7.6 mm and at both ends a diameter of 9 mm to allow strong locking bolts of 4.6 mm to increase stability. Patients and methodsWe conducted a prospective multicentre study to evaluate this implant. A total of 78 patients with 79 humeral fractures was included. Of these 79 were 50 acute, 17 non-unions and 12 pathological fractures.To evaluate the functional results of the 50 patients with fresh fractures, this group was evaluated.Between 2.5 and 7 years after their first operation 28 patients could be re-examined and their function evaluated. The shoulder function was evaluated with the Neer score, the elbow function with the Morrey score.To test for differences between both groups the Mann-Whitney-U and the chi-square tests were used. ResultsThere were 22 male and 28 female with a mean age of 57 years (15±87) and a mean follow-up of 36 months (0.5±86). Of these fractures 56 % were type A, 26 % type B and 18 % type C according to the AO. The location of the fracture was in 4 % subcapital, in 36 % in the proximal third, 46 % midshaft, and 14 % in the distal third.The mean operation time was 99 min. (45±340). The introduction was retrograde in 19 cases and antegrade in 31. Peroperative complications were in 4 cases a iatrogenic fracture which did not affect stability and in 6 cases an open procedure because of interposition of soft tissues 4 times, radial nerve lesion once and fracture reduction also once. Postoperatively we encountered 3 infections (6 %), 2 radial palsies and 1 non-union.In 98 % of 48 patients (2 polytrauma patients had died) the fracture healed after a mean of 16.5 weeks (6±45).In the functionally re-evaluated group were 15 male and 13 female with a mean age of 50 years (15±77). In 18 cases the nail had been introduced antegrade and in 10 cases retrograde. In 15 patients the nail had been removed. The fracture types according to the AO were in this group in 51 % type A, 30 % type B and 19 % type C. The fracture location was in 51 % midshaft, in 30 % proximal and in 19 % distal.The mean Neer-score was 86 (45±100), this is considered satisfactory. In 68 % the score was excellent, in 11 % satisfactory and in 21 % a failure. This high percentage of failure is attributed to concomittant lesions of the arm.