Management of fracture shaft of humerus by interlocking nailing

Abstract

Background: Humeral shaft fractures which account for approximately 1-3% of all fractures and 20% of humeral fractures are known to cause significant disability in the young which is often temporary and in the old often permanent disability. The use of locked intra-medullary nailing for the treatment of humeral shaft fractures is gaining popularity because of its biomechanical and biological advantages. Methods: We present a prospective study of 30 patients with acute humeral shaft fractures presented in HIMS Orthopaedic out-patient were treated using an ante-grade interlocking nail. Fracture union, functional outcome measured with criteria of Rommens et al and complications were assessed. Results: Patient age ranged from 20 to 65 years (Average, 39 years). There were 24 male patients and 6 female patients. Fracture of the middle third was most common accounting to 70% (21/30) of the fractures. Fracture union was achieved in 96.6% (29/30) of our cases. 1 patient had nonunion for which secondary surgeries were needed.1 patient had superficial infection. None of the patients had radial nerve palsy postoperatively. Functional results were graded according to the criteria of Rommens et al. Overall functional results were, Excellent in 26(86.6%) of patients, moderate in 3(10%) of patients and poor in 1(3.33%) of patients. Conclusions: Gentle progressive reaming, correct entry point, minimal damage to rotator cuff, properly embedding the tip of the nail, good apposition of fracture fragments, static locking will help make ante grade intra-medullary nailing, a dependable solution for the treatment of humeral shaft fractures and in achieving successful union with preserved/good shoulder and elbow function.