Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results

Abstract

We report our experience with a modified implant and a new technique for locked intramedullary nailing of the humerus in 41 patients. Locking was by cross-screws placed from lateral to medial in the proximal humerus, and anteroposteriorly in the distal humerus. Early in the series, 11 nails were inserted at the shoulder, but we found that rehabilitation was faster after retrograde nailing through the olecranon fossa, which was used for the other 30. We used a closed technique for 29 of the nailings. Of the 41 patients treated, 21 had acute fractures, five had nonunion, and 15 had pathological fractures. Secure fixation was obtained for comminuted and osteoporotic fractures in any part of the humeral shaft, which allowed the early use of crutches and walking frames. Two nails were locked at only one end, and one of these became the only failure of union after an acute fracture.

Humeral Shaft Fractures

“…Other consolidation rates from the use of intramedullary nails have been reported in the studies of Ingman and Waters (17) (97.6%), Rommens et al (18) (94.8%) and Scheerlinck and Handelberg (31) (93%). the operation did not present any statistically significant difference.…”

“…However, certain aspects of HSFs and patient characteristics make it difficult to carry out treatment using external immobilization. With increasing incidence of HSFs due to multiple trauma, exposed fractures and deviation caused by muscle action (9) , along with other factors such as obesity, which lead to poor results from nonsurgical treatment, many investigators have been seeking new treatment methods, such as the use of pins (15) , intramedullary nails (16) or screwed plates (17,18) . Thus, although most HSFs can be treated nonsurgically, the fracture characteristics and patient requirements should be fundamental with regard to indicating surgery (14) .…”

Outcome Assessment of Operative Treatment of Humeral Shaft Fractures by Antegrade Unreamed Humeral Nailing (UHN)

“…Nevertheless one of the common complications in this method is radial nerve injury, which has been reported in about 3-20 % of patients [5,6,8]; non-union has also been reported in about 2-6 % of patients [5,8,10,11]. In the UHN technique, radial nerve injury in 2-4 % of patients has been reported [7][8][9], and nonunion has been seen in 5-10 % of patients [9,[12][13][14]. In all these articles, proximal and distal locking has been performed simultaneously.…”

“…In all these articles, proximal and distal locking has been performed simultaneously. Malfunction of the shoulder has been reported in the antegrade technique due to rotator cuff injury [7,8]. This study has been performed with two main hypotheses:…”

“…Intra-medullary nailing is another appropriate surgical technique that could be performed through both antegrade and retrograde approaches. There are various results in the literature about unreamed humeral nailing (UHN) and some trials reported various rates of non-unions [7,8]. We believe that because of the shoulder joint's wide range of motion UHN with the antegrade approach without distal locking, except of little increasing the risk of non-union, will not cause any significant complication, but it may reduce the time of operation and lower the chance of radial nerve injury.…”