Internal fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective study

Abstract

Background:The indications for surgical management of fractures of the shaft of the humerus are clear, but selecting the right implant for internal fixation of humeral fractures has been a dilemma.Materials and Methods:Thirty-six patients (mean age 40.53 years) with fractures of the shaft of the humerus were followed for 12 to 24 months in a prospective study. Eighteen patients each underwent open reduction and internal fixation with compression plating and ante grade interlock nailing. Clinical and radiographic outcome measures included fracture healing, shoulder and elbow functions, need for additional procedures and any complication such as infection and recovery of radial nerve palsy. The results were analyzed statistically using the SPSS 11.5 software, with parametric and nonparametric tests.Results:Nine of the fractures treated with compression plating and seven of those treated with interlock nailing achieved union within six months. Though there was no significant difference in union time between the treatment groups, patients operated with interlock nailing underwent more number of secondary bone grafting procedures to obtain union (six against two). There were 12 patients (66.6%) with excellent and good results in the plating group compared to four patients (25%) in the nailing group. Interlock nailing was associated with significant reduction in shoulder function (P=0.03) and in overall results (P=0.02).Conclusion:Though there was no significant difference between plating or nailing in terms of time to union, compression plating is the preferred method in the majority of fractures of the shaft of the humerus with better preservation of joint function and lesser need for secondary bone grafting for union.

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

“…The higher rate of excellent and good results with the plating group patients seen in our series was also cited in many other reports [13,15]. But another series has suggested that both groups had predictable results and neither of them is markedly superior [7].…”

“…Impairment of shoulder function with the antegrade interlocking nails could be because of impingement due to proximal migration of nail, rotator cuff violation, adhesive capsulitis or due to an unexplained cause [6,7,15,17]. This problem can be potentially minimised by using a retrograde technique but carries a risk of elbow movement restriction and fracture at the insertion point [4,9,15]. Some report increased incidence of elbow stiffness with the plating group [7].…”

“…Restriction of shoulder movements and risk of delayed union have been suggested as concerns with the intramedullary techniques [3,4,7,9,13,16]. Impairment of shoulder function with the antegrade interlocking nails could be because of impingement due to proximal migration of nail, rotator cuff violation, adhesive capsulitis or due to an unexplained cause [6,7,15,17]. This problem can be potentially minimised by using a retrograde technique but carries a risk of elbow movement restriction and fracture at the insertion point [4,9,15].…”

Functional outcome of antegrade interlocking intramedullary nailing for humeral shaft fractures

“…[13][14][15][16][17] Shoulder pain and restriction of shoulder movements and risk of delayed union have been suggested as disadvantages of antegrade intramedullary fixation. [18][19][20] Impairment of shoulder function with antegrade IMN could be due to rotator cuff violation, and subacromial impingement. Baltov et al in their retrospective review of 105 patients treated with antegrade approach reported telescopic effect in 5 (4.5%) patients with osteoporosis, incomplete embedding of the nail at surgery, leading to sub acromial impingement in 12 (10.8%) cases, and in 5 (4.5%) patients impingement of the head of proximal interlocking screw as complications leading to shoulder discomfort.…”

Лiкування дiафiзарних переломiв плечової кістки за допомогою блокуючого iнтрамедулярного металоостеосинтезу в умовах Обласної лікарні інтенсивного лікування м. Маріуполя

“…Однією з найважливiших умов для зрощення переломiв є механічна стабільність уламків та малоiнвазивність з урахуванням опосеред-кованого пошкодження м'яких тканин, що суттєво впливає на процеси репаративної регенерацiї [4,6,10]. Також використання блокуючого iнтрамедулярного остеосинтезу (БІОС) надає можливiстъ забезпечен-ня раннього навантаження на оперовану кiнцiвку при мiнiмальному ризику виникнення нестабільності кісткових уламків чи імпланта та вiдновлення функції травмованої кінцівки в мiнiмальнi термiни [3,7,8].Мета дослiдження -оцiнити ефективнiсть вико-ристання методу блокуючого iнтрамедулярного остео-синтезу для лiкування постраждалих з діафізарними переломами плечової кістки. …”