Abstract
Introduction: The management of humeral diaphyseal fractures is in a state of flux, with humeral plating becoming more popular than humeral nailing. This change of opinion has been stimulated primarily by the American literature, which quotes significant complication rates associated with humeral nailing.
Methods: We undertook a retrospective study, over a consecutive seven year period, to evaluate the complication rate and the functional outcome (American DASH scoring system) following humeral nailing. The study group was composed of 91 patients, with an average age of 50 years (22–90). All cases were performed by a consultant or under their direct supervision. The minimum follow-up was one year.
Results: Of the 91 cases, 7 were lost to follow-up. Non-union was seen in 4 cases, all requiring removal of nail with additional surgical procedures. Delayed union was seen in 2 cases. Nail prominence causing impingement pain was seen in 4 cases, necessitating nail removal. In 3 cases, the proximal screws loosened and in 1 case the distal screw loosened, necessitating removal. One case required an exchange nailing to improve stability and one nail became infected, again demanding removal. Thus significant complications were seen in 16 of 84 (19%) cases. The functional outcome was good to excellent in 51 cases and poor to moderate in 33 cases.
Conclusion: Based on our results, we agree with the current move away from humeral nailing as the procedure of choice for humeral diaphyseal fractures. We are supportive of the move towards humeral plating.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at Irish Orthopaedic Associaton, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11.
