Outcome of Intramedullary nailing of humeral shaft fractures

Dr Naved Ahmed Farid Ansari; Dr Dhiraj Vithal Sonawane; Dr Sandeep V Gavhale

Volume : VIII, Issue : IX, September - 2019

Outcome of Intramedullary nailing of humeral shaft fractures

Dr Naved Ahmed Farid Ansari, Dr Dhiraj Vithal Sonawane, Dr Sandeep V Gavhale

Abstract :

There are several modalities for the management of diaphyseal humeral fractures, though conservative management remains the gold standard treatment, method of treatment of fractures of shaft humerus surgically is always a dilemma to deal with as they are mostly associated with their own sets of complications. Interlocking intramedullary interlocking nails have gained popularity for stabilization of humeral shaft fractures due to reduced intraoperative time, minimally invasive surgery, load sh� nature of the implant, preservation of fracture haematoma, minimal exposure decreased blood loss and rigid fixation with early mobilization. Intramedullary Interlocking nailing (IMIL) is an accepted technique for the treatment of humeral shaft fractures. Previous studies published concerns over reliability of this technique as to higher complication rates such as nonunion and technical failures compared to plate osteosynthesis. Here we have conducted a study of intramedullary nailing in 73 patients with fracture shaft humerus. Materials and methods Between jan 2014 and jan 2019, a prospective clinical study on 73 patients of humeral shaft fractures was performed using antegrade locked intramedullary nailing in hospital setting at multiple centres to evaluate the outcome and incidence of complications associated with this method of humeral shaft fracture fixation. The study had follow up period of 6 months. Inclusion criteria were skeletal maturity and humeral shaft fractures treated with IMIL. Exclusion criteria were skeletal immaturity, primary treatment by plate osteosynthesis, presence of metaphyseal fractures and the presence of pathological fractures. Negative outcome measures such as infection, non union and early technical failure were retrospectively assessed. Results: Intramedullary nailing could treat majority of patients successfully with non-union occurring in total four out of 73 patients (5.4%) . Superficial wound infection occurred in two cases (2.7%) with no single case of deep infection. Shortening of 1 cm respectively was observed in single case (1.3%). Mild restriction of shoulder movements remained in two out of 73 patients (2.7%) at 6 months, and single patient (1.3%) developed hypertrophy of scar. Conclusions IMIL is a valid therapeutic option for humeral shaft fractures. Good surgical technique and soft tissue handling are important for good outcome. Currently, patient demands are receiving greater consideration. In an era where early full range of motion and rapid return to work with minimal sc� is demanded by most patients, the use of IMN will most likely increase in popularity in the near future.