Retrograde nailing of humeral shaft fractures with the UHN. An international multicenter survey

Abstract

Combined with the new unreamed humeral nail (UHN) (Synthes), the retrograde approach to the endomedullary canal of the humeral shaft promises careful reduction and fixation of humeral shaft fractures. This prospective multicenter study reports and analyses 102 retrograde nailings with the UHN and their operative procedures. Seven patients with pathological fractures have died meanwhile, but 75 patients could be followed up until bone healing. Seventy-three fresh humeral shaft fractures, 12 pseudarthrosis, 3 refractures and 14 pathological fractures have been treated with the UHN. In 98 cases (96.1%) the surgeon estimated fracture stability well enough to initiate immediate postoperative elbow and shoulder mobilization. The difficulties involved with free-hand interlocking proximally at the nail tip in 5.9%, fissure or avulsion at the insertion point in 3.9% and radial nerve palsy also in 3.9% of the cases were the most important intraoperative complications. In all 75 patients followed up, bone healing occurred, but five fractures (6.7%) needed more than 8 months connected with a second operative procedure. In one case spongious bone transplantation and new locking bolts had been performed. In three cases a special compression device has been used, whereas in one case also a new nail and in the second spongious bone transplantation had been added. In the fifth case plate osteosynthesis had been performed. At the end of treatment 89.4% of the patients had excellent shoulder function and 88.0% excellent elbow function. Once the indication for surgery is established, the UHN can be considered a reliable and safe implant for stabilizing humeral shaft fractures.

Humeral shaft fractures

“…An intramedullary nail performed with attention to technical detail has a high incidence of union and good functional outcomes [43,44]. While antegrade nails are more common and easier to perform, retrograde humeral nails are a consideration in distal shaft fractures and have the same union rate as antegrade [45]. To avoid angular malalignment, iatrogenic supracondylar fracture, and olecranon impingement, an in-line start site in the superior olecranon fossa is advocated.…”

Die winkelstabile Marknagelung bei Frakturen am proximalen Humerus mit dem PHN (Proximaler Humerusnagel)

“…Bis vor wenigen Jahren war die Marknagelung des Humerus auf Schaftfrakturen beschränkt [2,4,5,7,[24][25][26]. Die bis dahin üblichen Insertions-und Stabilisierungstechniken solcher Marknagelsysteme schienen metaphysären oder gar epiphysären Frakturen nicht gerecht zu werden [6,20,27].…”

Intramedullary Nailing of Humeral Head and Humeral Shaft Fractures

“…Since modern humeral nail systems led to smaller nail diameters and furthermore follow an unreamed technique, the contrast between antegrade and retrograde approaches is less sharp today. For proximal metaphyseal fractures, the antegrade approach is the appropriate one; in pure diaphyseal fractures, we still prefer the retrograde approach, if possible [2,12,19,26].…”

“…Furthermore, patient's expectations for an early mobilization under stable condition of the humerus are also increasing [2,3].…”