Abstract
The Halder Nail was introduced into the UK in 1994 and the inventor has recently reported his results (Halder et al, 20011). Our unit has used the Halder humeral nail since 1997 for the management of traumatic and pathological fractures of the proximal humerus.
Methods: We conducted a retrospective cohort study of all patients undergoing Halder nailing from March 1997 to February 2001. 50 patients were included with a follow up of 3 months to 4 years. Fractures were classified into trauma related and pathological. Trauma related fractures were subdivided into 2-, 3- and 4-part fractures of the surgical neck, and humeral shaft fractures. Post-operative Constant scores were obtained for 34 patients.
Results: Thirty-two female and 18 male patients were included with a mean age of 69 years. There were 6 humeral shaft fractures; 13 2-part; 7 3-part and 9 4-part humeral neck fractures. There were 15 cases of nailing in pathological bone.
Trauma Cases: Of the 35 trauma related fractures there were 15 cases of non-union, and 12 cases of delayed union (time to union > 3 months). Postoperative radiographs demonstrated good reduction in 27of these 35 cases. The nail was removed in 16 cases due to impingement problems at the shoulder. Four patients subsequently required a hemiarthroplasty or dynamic compression plating following nail removal. In addition there were 6 cases of trio wire protrusion and 2 cases of broken wires. Of the 28 patients on whom post-op Constant scores had been obtained 8 scored 60% or above, 11 scored 40–59% and 9 scored 39% or less.
Pathological Cases: There were 8 cases of established pathological fractures and 7 cases of prophylactic nailing in pathological bone. Good postoperative reduction was demonstrated in 14 of the 15 patients. There were 2 cases of wound infection and 2 cases of nail impingement. 13 of the 15 patients reported good pain relief following fixation.
Conclusion: Despite good radiographic reduction following Halder nailing, non-union, delayed union and nail impingement were common in the trauma group. However the Halder nail did provide reliable and immediate pain relief and stability of the bone to allow healing in patients with pathological humeral fractures.
The abstracts were prepared by David Stanley. Correspondence should be addressed to him c/o British Orthopaedic Association, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
1) Halder SC, Chapman JA, Choudhury G, Wallace WA (2001) Retrograde fixation of fractures of the neck & shaft of the humerus with the Halder Humeral Nail. Injury, 32: 695–703 Google Scholar
