Surgical Outcome of Diaphyseal Fractures of Humerus by Antegrade Interlocking Nailing in Closed Reduction

Abstract

BACKGROUND: Fractures involving the shaft of humerus are commonly encountered by orthopedic surgeons in day to day practice. Humeral shaft fracture can be treated using intramedullary fixation technique. Flexible intramedullary nails like Rush nail, Enders nail have been used utilizing ante grade and retrograde methods. This technique has largely replaced plating method very often. But, retrograde nailing can be regarded as a minimally invasive procedure and justifiable to use for fixation of isolated humeral shaft fractures in certain situation. In this study we have evaluated the effectiveness of surgical and functional outcomes of closed ante grade interlocking nailing in the management of diaphyseal fractures of humerus. METHODS: A series of 30 patients with diaphyseal fractures of humerus were treated with ante grade interlocking nailing during October 2008 to October 2010. All the patients were followed up 6 weeks, 12 weeks and 24 weeks and results were analysed. X rays were taken to assess radiological union of fracture during the follow up. Assessment of fracture union and shoulder and elbow movement was recorded. Final evaluation was done at the end of 6 months. Data was presented as mean ± SD, actual numbers and percentages. Wilcoxon test and chi-square test were used appropriately. RESULTS: All 30 patients in our study were followed up for a minimum period of 6 months. 56.7%cases were male patients 43.3% were female patients. More than 50 % of cases in the series were between the ages of 18-35 years. 60% fractures were comminuted 6.6% were of oblique type, 33.3% were of transverse type. The average time interval from the time of admission to the time of surgery was 3 days. The most common mode of injury was road traffic accident. Commented fractures are predominant in our study. Clinical outcome was 60% of cases had excellent results and 30 % had moderate result. 3 patients (10%) had poor result, due to limitation of shoulder abduction, resulting from irritation of rotator cuff from protruding proximal end of the nail. CONCLUSION: Closed intramedullary interlocking nailing in humeral diaphyseal fractures results in early fracture union and early recovery of range of movements at shoulder and elbow joints. This method also preserves fracture hematoma facilitating early periosteal callus formation and union. It also limits extensive soft tissue dissection, periosteal stripping and devitalization of bone fragments in comminuted and segmental fractures thereby minimizing the changes of nonunion. Closed nailing minimizes the risk of iatrogenic, radial nerve injury, reduces the operative time and blood loss.