RETROGRADE ELASTIC INTRAMEDULLARY NAILING OF THE HUMERUS: A REPORT OF 20 SHAFT FRACTURES TREATED WITH THE MARCHETTI-VICENZI NAIL

Abstract

To study the outcome of stabilisation of humeral shaft fractures using an elastic retrograde humeral nail that is self-locking proximally and easily locked distally.

20 closed humeral shaft fractures were stabilised in 19 patients between 1996 and 1999.

There were three acute fractures, nine cases of failed non-operative treatment (three cases of loss of fracture position and six cases of non-union), five established pathological fractures and three impending pathological fractures. The average age of the patients in the acute/failed non-operative treatment group was 43. 6 years (range 18 to 83 years) and in the established/impending pathological fracture group was 73. 6 years (range 60 to 81 years).

Patients in the acute/failed non-operative treatment group were followed until fracture union. This occurred without further intervention in 83% of cases at a mean of 11. 8 weeks (range 10 to 16 weeks). Shoulder and elbow movement were rated by determining the percentage loss of movement compared to the other side. Almost all these patients regained a full range of elbow and shoulder movement without residual pain or disability. Two cases needed further surgery to achieve union and it was noted that nail removal in these patients was difficult. In one of these cases the original injury was a floating elbow. All of the pathological fractures were successfully stabilised with good pain relief. Four of the five patients with established fractures survived to fracture union. This occurred at a mean of 12. 5 weeks (range 10 to 16 weeks) without the need for further procedures. There were few complications.

We have obtained encouraging results with both pathological and non-pathological fractures using this nail with good preservation of both shoulder and elbow movement. We have continued to use the nail routinely.