Humeral Nail: Comparison of the Antegrade and Retrograde Application

Abstract

SUMMARY -Application of humeral nail in the treatment of humeral shaft fractures is a relatively novel method of fracture fixation. Its application at Clinical Department of Traumatology, Sestre milosrdnice University Hospital Center began in 2001. The operative procedure should be performed using a minimally invasive technique without fracture opening in order to maintain optimal conditions for fracture healing including hematoma management. However, in everyday practice it is often impossible to obtain satisfactory fracture reduction using the closed procedure, so open reduction and additional fixation with wires or screws are mandatory. Over the last 14 years, fixation of fractures with the locking nail was performed in more than 400 patients. Cases of pseudarthrosis and pathological fractures were also managed successfully. There were more female patients. The mean time from injury to surgery was 2.4 days. Surgery was performed immediately upon admission to the emergency service whenever possible. This study comprised 234 patients with humeral shaft fractures treated with the humeral nail (antegrade insertion was applied in 103 and retrograde in 131 patients). The aim of the study was to stress out the complexity of appropriate operative treatment of humeral shaft fractures using intramedullary fixation, as well as the importance of proper reduction and stable fixation.

Lateral condylar retrograde humeral nail for management of high-energy distal humeral fractures

“…[12][13][14][15] When retrograde humeral nail is applied, the distal part of the humerus should be intact allowing proper insertion of the nail to avoid the potential complication of longitudinal shuttering of the humeral shaft. 12 Complex distal humeral fractures represent an obstacle for both retrograde humeral nail insertion and application of the distal locking screws of the antegrade humeral nail. In such situations, plating and external fixation seem rational alternatives.…”

“…Consequently, the patient gets immediate pain relief, earlier rehabilitation, and better nursing. 12…”

“…Nevertheless, the use of antegrade humeral nail carries the potential risk of rotator cuff injury, shoulder impingement, injury of axillary nerve, circumflex arteries, or biceps tendon irritation, which could result from proximal screws insertion. 12 –15…”

“…Consequently, the patient gets immediate pain relief, earlier rehabilitation, and better nursing. 12 Nevertheless, the use of antegrade humeral nail carries the potential risk of rotator cuff injury, shoulder impingement, injury of axillary nerve, circumflex arteries, or biceps tendon irritation, which could result from proximal screws insertion. [12][13][14][15] When retrograde humeral nail is applied, the distal part of the humerus should be intact allowing proper insertion of the nail to avoid the potential complication of longitudinal shuttering of the humeral shaft.…”

“…12 Nevertheless, the use of antegrade humeral nail carries the potential risk of rotator cuff injury, shoulder impingement, injury of axillary nerve, circumflex arteries, or biceps tendon irritation, which could result from proximal screws insertion. [12][13][14][15] When retrograde humeral nail is applied, the distal part of the humerus should be intact allowing proper insertion of the nail to avoid the potential complication of longitudinal shuttering of the humeral shaft. 12 Complex distal humeral fractures represent an obstacle for both retrograde humeral nail insertion and application of the distal locking screws of the antegrade humeral nail.…”