Locked Intramedullary Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures

Abstract

PURPOSE. To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. METHODS. 32 men and 2 women with humeral shaft fractures were randomised to undergo locked antegrade intramedullary nailing (IMN, n=16) or dynamic compression plating (DCP, n=18). Patients with pathological fractures, grade-III open fractures, neurovascular injury, or fractures for more than 2 weeks were excluded. Fractures were classified according to the AO classification system (one in A1, 6 in A2, 12 in A3, 6 in B1, and 9 in B2). 28 were injured in road traffic accidents. The functional outcome (according to the American Shoulder and Elbow Surgeons [ASES] score) and rates of union and complication of the 2 groups were compared. RESULTS. All patients were followed up for a minimum of 24 months. In the respective IMN and DCP groups, the mean ASES scores were 45.2 and 45.1 (p=0.69), the complication rates were 50% and 17% (p=0.038), and the non-union rates were 0% and 6% (p=0.15). In the IMN group, 2 sustained iatrogenic fractures during nail insertion; 2 had transient radial nerve palsies; one underwent nail removal for shoulder impingement; and 3 had adhesive capsulitis. In the DCP group, one underwent re-operation for implant failure; one had a superficial infection; and one developed adhesive capsulitis. CONCLUSION. The complication rate was higher in the IMN group, whereas functional outcomes were good with both modalities.

Treatment of Two-Part Proximal Humerus Fractures: Intramedullary Nail Compared to Locked Plating

“…Putti et al [14] reported findings on the comparison of these two methods for the fixation of humeral shaft fractures, and while they found similar functional outcomes at 24-month follow-up on the American Shoulder and Elbow Surgeons (ASES) scale (45.2 with IMN and 45.1 with locking plate), their results demonstrated a significant difference in complication rate. Among their 34 patients, there was a 50 % complication rate in the IMN group compared to 17 % in the LP group.…”

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

“…The usual operative methods used are the dynamic compression plate (DCP) and intramedullary nail. 3,7,8 Plate fixation results in high union rates, but requires extensive dissection and stripping of soft tissues from the bone, which is associated with a greater risk of radial nerve damage. [7][8][9] The neuro vascular and muscular anatomy of the humerus precludes the use of a fully extensile approach that is truly safe.…”

“…The lateral approach is used for the distal quarter of the humerus. 7,8,[10][11][12][13] Surgical treatment carries specific risks related to the close anatomic relationships among the bone, nerves and blood vessels. Iatrogenic injury of the radial nerve occurs in 10%-25% of patients as a result of contusion, stretch or direct damage.…”

Two-Part Proximal Humerus Fractures: Whether to Plate or Nail?

“…In our study none of the implants were preferred for any specific age group and patient selection was randomized and blinded. Putti et al 9 found that on the comparison of ILN and LP fixation of humeral shaft fractures had similar functional outcomes at 24-month follow-up on the American Shoulder and Elbow Surgeons (ASES) scale (45.2 with IMN and 45.1with locking plate), but their results demonstrated a significant difference in complication rate. In their study among 34 patients, there was a 50 % complication rate in the IMN group compared to 17 % in the LP group.…”