Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail

Abstract

We randomised prospectively 44 patients with fractures of the shaft of the humerus to open reduction and internal fixation by either an intramedullary nail (IMN) or a dynamic compression plate (DCP). Patients were followed up for a minimum of six months. There were no significant differences in the function of the shoulder and elbow, as determined by the American Shoulder and Elbow Surgeons' score, the visual analogue pain score, range of movement, or the time taken to return to normal activity. There was a single case of shoulder impingement in the DCP group and six in the IMN group. Of these six, five occurred after antegrade insertion of an IMN. In the DCP group three patients developed complications, compared with 13 in the IMN group. We had to perform secondary surgery on seven patients in the IMN group, but on only one in the DCP group (p = 0.016).Our findings suggest that open reduction and internal fixation with a DCP remains the best treatment for unstable fractures of the shaft of the humerus. Fixation by IMN may be indicated for specific situations, but is technically more demanding and has a higher rate of complications.

Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures

“…Both, ORIF and IN are well-established procedures with high rates of 85-93 % of recovery following primary radial nerve palsy [12,[17][18][19][20][21]. In the case of acute primary radial nerve palsy open reduction facilitates fracture treatment and enables simultaneous exploration of the radial nerve to determine the extent and the type of lesion [1,7,18].…”

Nailing versus plating in humerus shaft fractures: A prospective comparative study

“…While there are several methods of operative intervention for humerus shaft fractures, the internal fixation methods can be broadly grouped as plating or intramedullary techniques. Interlocking nailing is preferable in communited, segmental and pathological fractures while plating may be the preferred option where radial nerve exploration is contemplated [5,13,14]. Conventional plating techniques involve an extensive surgical approach for open reduction of fracture.…”

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

“…In comparison with mentioned studies, our technique can significantly reduce the operating time of nail insertion in patients with humeral shaft fractures (P<0.05). McCormack et al [17] compares the outcomes of humeral shaft fractures via intra-medullary nailing and dynamic compression plate, and the rate of non-union in the nailing group was 9.5 %. Also, Singisetti and Ambedkar [4] in a prospective study compared the clinical results of nailing and plating, and the non-union rate of the nailing group was 5 %.…”

“…With regard to the above studies, our technique leads to slightly increased non-union rate. McCormack et al [17] reported three cases of post-operative radial nerve palsy among 21 patients who underwent intra-medullary nailing (14.2 %). In our patients, only one case of post-operative radial nerve palsy was detected, and the patient recovered after about 6 weeks of operation.…”