LOCKED RETROGRADE NAILING FOR FRACTURES OF THE HUMERUS: 50 CASES

Abstract

Purpose: We report our first cases of retrograde nailing using the universal humerus nail (UHN).

Material and methods: Fifty patients (26 men and 24 women), mean age 60.2 years, with fracture of the humerus were treated with the UHN; most had shaft fractures, 40 were trauma victims, and ten had metastases.

Retrograde nailing was achieved by trepanation of the apex of the olecranon fossa. Proximal or distal locking was applied in all cases using one or more screws. Outcome was assessed with the S.O.O. criteria (1996).

Results: Two patients were lost to follow-up and two patients died early. Forty-six patients were reviewed with a mean follow-up of six months (range 3–18). Outcome was very good or good in 43 patients (bone healing at three months), fair in one, poor in two (two constructs dismounted at day 15); three asymptomatic fractures did not heal at one year (all healed two months after compression). Peroperative complications included: four fissures of the posterior cortical at the entry window and two supracondylar fractures. One patient developed radial palsy in the immediate postoperative period that resolved spontaneously. One of the proximal locking screws loosened early in four patients. Finally, one patient developed a supracondylar fracture at the point of entry following a fall four months after the nailed fracture had healed.

Discussion: The two cases of dismounting were subtuberosity fractures in elderly patients; likewise the one fair outcome was a minimal secondary displacement that had not healed at five months. The proximal locking screws did not hold well in osteoporotic heads explaining the three cases of early screw loosening. Impacting the curved nail into the last centimeters is a delicate operation and we had two fissures of the posterior cortical and peroperative supracondylar fractures early in our experience. Finally, the absence of an aiming device for the proximal locking screw complicates this procedure. The possibility for orthogonal proximal locking is however an advantage for rotatory stability. This nail allows early rehabilitation without mobilisation.

Conclusion: Retrograde locked nailing provides good results at three months for humeral shaft fractures. Subtuberosity fractures in elderly patients are not good indications. A straight nail would however be preferable and an aiming device for the proximal locking would be useful.