Comparison between functional bracing and locked intramedullary nailing in isolated and closed humeral shaft fractures
Özcan Pehlivan1, M Ömer Arpacıoğlu2, Ahmet Kıral1, İbrahim Akmaz1, Mahir Mahiroğulları1, Haluk Kaplan1
1Department of Orthopedics and Traumatology, GATA Haydarpaşa Training Hospital
2Department of Orthopedics and Traumatology, Medicine Faculty of Gaziantep University
Keywords: Bone nails; braces; fracture fixation, intramedullary/ methods; fractures, closed; humeral fractures; range of motion, articular.
Objectives: We retrospectively compared the treatment results of functional bracing and locked intramedullary nailing for humeral shaft fractures in two similar patient groups.
Patients and methods: Sixty-seven patients were treated conservatively with a prefabricated functional brace (group 1, n=35, mean age 34 years) or surgically with a locked intramedullary nail (group 2, n=32, mean age 37 years) for acute, isolated, and closed humeral shaft fractures. The average time from injury to treatment was five days (range 2 to 11 days) in group 1, and four days (range 1 to 7 days) in group 2. The results were assessed according to the Constant-Murley shoulder scoring system. The mean follow-up was 15.2 months in group 1 and 16.3 months in group 2.
Results: Hospitalization was significantly shorter in group 1 (mean, 7 days versus 21 days; p=0.001). The average time to union was 13.4 weeks in group 1, and 13.9 weeks in group 2 (p=0.5). Eleven patients (31.4%) and two patients (6.3%) developed an average varus angulation of 8.5° and 5° in group 1 and 2, respectively. Three patients (8.6%) had apex-anterior angulation (mean 7°), and one patient (2.9%) had 4° apex-posterior angulation in group 1. Three patients (8.6%) in group 1, and two patients (6.3%) in group 2 had abduction losses of less than 10°. External rotation of the shoulder decreased by less than 10° in two patients (5.7%) in group 1 and in two patients (6.3%) in group 2. Shortening (range 5 to 20 mm) developed in four patients in group 1. One patient (2.9%) with a transverse fracture developed nonunion in group 1. Prominence of the proximal end of the nail was seen in two patients (6.3%), one of which required removal. The results were all excellent or good in both groups, with an average score of 86.5 in group 1, and 85.9 in group 2 (p=0.7).
Conclusion: Although both methods offer satisfactory results in the treatment of humeral shaft fractures, we recommend functional bracing as the method of choice unless it is contraindicated.