Osteosynthesis and Trauma Care 2003; 11: 58-63
DOI: 10.1055/s-2003-42299
Humerus

© Georg Thieme Verlag Stuttgart · New York

Antegrade Intramedullary Nailing in Humeral Shaft Fractures

P. Dimakopoulos1 , M. Papas1 , A. Kaisidis1 , A. Panagopoulos 1 , E. Lambiris 1
  • 1 Orthopaedic Department of Patras University Hospital, Patras, Greece
Further Information

Publication History

Publication Date:
24 September 2003 (online)

Abstract

Purpose: To evaluate union time and functional recovery of the shoulder joint in humeral shaft fractures treated with intramedullary nailing.
Material and Methods: During the period 1990-2001, 43 patients with humeral shaft fractures were treated with intramedullary nailing. 38 patients (21 males and 17 females, mean age 48 years) were available at the final follow-up evaluation after 21 months on average. In 25 patients the entry point was below the greater tuberosity to avoid rotator cuff injury and in the other 18 patients the entry point was intra-articular. Passive shoulder and elbow motion was allowed from the second postoperative day followed by active assisted exercises from the second postoperative week. Union progress was assessed radiologically at 2nd, 4th, 8th, and 16th postoperative week whereas final shoulder function was evaluated using the parameters of the Constant-Murley scoring system.
Results: Solid callus formation was noted in all fractures, except one, between the 8th and 35th postoperative week. Patients with extra-articular application of the nail had full passive shoulder motion between the 2nd and the 4th postoperative week whereas patients with intra-articular application had delayed passive shoulder motion and final functional limitation. Seven patients had painful shoulder motion 3 months postoperatively. There were 4 patients with transient radial nerve palsy, who demonstrated full functional recovery after 3 to 6 months and 3 patients with proximally migration of the nail underwent reoperation.
Conclusions: Intramedullary nailing in humeral shaft fractures seems to be a reliable method of treatment regarding union and functional recovery. Advantages are shorter operative time, minor blood loss, small incision with shorter soft tissue detachment and early mobilization of the shoulder, especially in the patients with extra-articular nail application without rotator cuff injury.

References

  • 1 Balfour G W, Mooney V, Ashby M E. Diaphyseal fractures of the humerus treated with a ready-made fracture brace.  J Bone Joint Surg [Am]. 1982;  64 11-13
  • 2 Bell M J, Beauchamp C G, Kellam J K. et al . The results of plating humeral shaft fractures in patients with multiple injuries: the Sunnybrook experience.  J Bone Joint Surg [Br]. 1985;  67 293-296
  • 3 Brumback R J, Bosse M J, Poka A. et al . Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma.  J Bone Joint Surg [Am]. 1986;  68 960-970
  • 4 Chapman J R, Henley M B, Agel J, Benca P J. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates.  J Orthop Trauma. 2000;  14 162-166
  • 5 Dabeziers E J, Banta C J, Murphy C P. et al . Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries.  J Orthop Trauma. 1992;  6 10-13
  • 6 Forster R J, Dixon G L, Bach A W. et al . Internal fixation of fractures and non-unions of the humeral shaft: indications and results in a multi-center study.  J Bone Joint Surg [Am]. 1985;  67 857-864
  • 7 Gregory P, Sanders R. Compression plating versus intramedullary fixation of humeral shaft fractures.  J Am Acad Orthop Surg. 1997;  5 215-223
  • 8 Hall R F, Pankovich A M. Ender nailing of acute fractures of the humerus: a study of closed fixation by intramedullary nails without reaming.  J Bone Joint Surg [Am]. 1987;  69 558-567
  • 9 Henley M B, Chapman J R, Claudi B F. Closed retrograde Hackethal nail stabilization of humeral shaft fractures.  J Orthop Trauma. 1992;  6 18-24
  • 10 Ikpeme J O. Intramedullary interlocking nailing for humeral fractures: experiences with the Russell-Taylor humeral nail.  Injury. 1994;  25 447-455
  • 11 Ingman A M, Waters D A. Locked intramedullary nailing of humeral shaft fractures: implant design, surgical techniques and clinical results.  J Bone Joint Surg [Br]. 1994;  76 23-29
  • 12 Klenerman L. Fractures of the shaft of the humerus.  J Bone Joint Surg [Br]. 1966;  48 105-111
  • 13 Mackay I. Closed Rush pinning of fractures of the humeral shaft.  Injury. 1984;  16 178-181
  • 14 Raschke M, Khodadadyan C, Maitino P D. et al . Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.  J Orthop Trauma. 1998;  12 138-141
  • 15 Remiger A R, Miclau T, Lindsey R W. et al . Segmental avascularity of the humeral diaphysis after reamed intramedullary nailing.  J Orthop Trauma. 1997;  11 308-311
  • 16 Riemer B L, Butterfield S L, D’Ambrosia R. et al . Seidel intramedullary nailing of humeral diaphyseal fractures: a preliminary report.  Orthopedics. 1991;  14 239-246
  • 17 Robinson C M, Bell K M, Court-Brown C M. et al . Locked nailing of humeral shaft fractures: experience in Edinburgh over a two-year period.  J Bone Joint Surg [Br]. 1992;  74 558-562
  • 18 Rommens P M, Vansteenkiste F, Stappaerts K H. et al . Indikationen, Gefahren und Ergebnisse der operativen Behandlung von Oberarmfrakturen.  Unfallchirurg. 1989;  92 565-570
  • 19 Ruf W, Pauly E. Zur Problematik der Humerusverriegelungsnagelung.  Unfallchirurg. 1993;  96 323-328
  • 20 Rush J. Closed nailing of the humerus: from down under.  Aust N Z J Surg. 1987;  57 723-725
  • 21 Sarmiento A, Kinman P B, Galvin E G. et al . Functional bracing of fractures of the shaft of the humerus.  J Bone Joint Surg [Am]. 1977;  59 596-601
  • 22 Wisniewski T F, Radziejowski M J. Gunshot fractures of the humeral shaft treated with external fixation.  J Orthop Trauma. 1996;  10 273-278
  • 23 Yang K H, Han D Y, Kim H J. Intramedullary entrapment of the radial nerve associated with humeral shaft fracture.  J Orthop Trauma. 1997;  11 224-226
  • 24 Zinman C, Norman D, Hamoud K. et al . External fixation for severe open fractures of the humerus caused by missiles.  J Orthop Trauma. 1997;  11 536-539

Panayotis Dimakopoulos M. D.

Orthopaedic Department

Patras University

Papanikolaou str.

26500 Rio-Patras

Greece

Phone: +30/26-10-99 95 51

Email: andpan21@medscape.com

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