Is locked compressive intramedullary nailing for adult humerus shaft fractures advantageous?
Fatih Duygun, Cengiz Aldemir
Department of Orthopedics and Traumatology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
Keywords: Compression; humerus fracture; intramedullary nail; union.
Objectives: This study aims to evaluate the radiological and functional outcomes of locked compressive intramedullary nailing (IMN) cases in adult humerus shaft fractures.
Patients and methods: A total of 24 patients (12 males, 12 females; mean age 42 years; range 23 to 55 years) with humerus fractures were treated with locked compressive IMN at the Orthopaedics and Traumatology Clinic, Antalya Training and Research Hospital between December 2009 and March 2015. Fluoroscopy was used only to check fracture reduction before the reaming procedure. Of the patients, closed IMN was performed in 21, while open reduction was performed in three. Lock screws were locked without fluoroscopy in all patients. Of the patients in whom open reduction was performed, radial nerve lesion developed in one. Anteroposterior and lateral graphs of all patients were taken postoperatively. Fracture union was assessed according to existence of the fracture line and the callus tissue in the anteroposterior and lateral graphs. The Constant-Murley scoring system was used for functional evaluation. The mean follow-up period was 24 months (range 12 to 72 months). Finite element analysis was performed for the stress distribution on fracture site.
Results: Radiological fracture union was achieved in all patients at mean 14.8 weeks (range 12 to 17 weeks). The Constant-Murley score was mean 90 (range 72 to 100). There was a statistically significant, negative and strong correlation between union period and the Constant-Murley score (r=-0.78, p<0.001). In one patient who developed postoperative radial nerve symptoms, all functions were regained in fourth month. No infection occurred in any patient. In two patients, tip of the nail remained high. Of these patients, one developed impingement findings, and the other patient had no problems.
Conclusion: Treatment of humerus shaft fractures with locked compressive IMN provides sufficient fixation and early movement opportunity in the shoulder and elbow joints, and gives satisfactory radiological and functional results.