Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study

Abstract

The aim of this study was to compare the results of the humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of the humerus. Forty-seven patients with diaphyseal fracture of the shaft of the humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were grade 1 or 2a compound fractures, polytrauma, early failure of conservative treatment and unstable fractures. The patients with pathological fractures, grade 3 open fractures, refractures and old neglected fractures of the humerus were excluded from the study. Twenty-three patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach.

Comment on Changulani et al. “Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study”

“…Radial nerve-related complications have been quoted as approaching 3% in humeral dynamic compression plating (DCP) [2]. In their study the authors reported nerve-related complications as being 4.1% and 4.7% in DCP and intramedullary nailing (IMN) [3]. Thus, we feel that the nerve-related complications are not a point against plating.…”

“…2. The authors mention implant removal, usually at 12 months, in their Methods section [3]. We would like to know whether implants were removed from all the patients or only from a selected group.…”

“…3. The authors mention that 12 out of 23 patients in the IMN group (>50%) underwent bone grafting [3].…”

Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion

“…The treatment of humeral shaft nonunion is often complex and technically demanding. The last decade has witnessed much technical improvement in various internal fixation devices and surgical approaches for the treatment of humeral shaft nonunion, including the application of cancellous bone grafting plus dynamic compression plate, intramedullary nails, external fixation frames and transplantation of vascularised bone graft [1,2,5,17,19].…”

Grafting may effect the outcome in diaphyseal fractures of the humerus

“…A randomised controlled study." with great interest [1]. In their study, the authors compared the results of the humerus intramedullary nail (IMN) in 23 patients and the dynamic compression plate (DCP) in 24 patients for the management of diaphyseal fractures of the humerus.…”