Mid-Term results in adult humeral fractures with titanium elastic nail fixation versus plate and screw fixation and locking intramedullary nailing

Abstract

Aims: To compare plate-screw fixation, intramedullary nailing (IMN), and titanium elastic nailing (TEN) as a new fixation method with respect to nonunion, complication rates, and functional outcomes in the repair of adult humeral shaft fractures. Methods: A total of 38 adult patients who were treated due to humeral shaft fracture at our clinic and were followed for minimum six months between January 2012 and January 2015 were retrospectively analyzed. Age, sex, fracture etiology an length of hospitalization were recorded. Fractures were classified according to the Association for Osteosynthesis(AO) classification. Nonunion rates as assessed by X-ray during visits, angulation, shoulder, elbow and hand disability scores were evaluated using the DASH, Mayo Elbow and UCLA Shoulder scoring, and Stewart Hundley criteria. Results: There was no significant epidemiological difference between the groups. The length of hospitalization was lower in the TEN group. There was no significant difference in nonunion rates and functional scores according to the type of treatment. Angulation rate was slightly higher in the TEN group. The effect of angulation on functional score showed no influence on the functional status. The three treatment types mostly achieved excellent and good outcomes. Conclusion: Our study results suggest that TEN seems to be a good alternative treatment in eligible patients with humeral shaft fractures considering complications of other treatments. However, we believe that further, large-scale, randomized-controlled, prospective studies with longer follow-up duration are required to confirm these findings and to establish a definite conclusion. Level of Evidence: Therapeutic Level III.