Abstract
The retrograde Marchetti-Vicenzi humeral nail consists of four or five flexible branches. At one end these branches are fixed into a solid L-shaped cylinder and at the other, they are held together with a locking wire. The nail is inserted in a retrograde way through a cortical window proximal to the olecranon fossa. Once passed the fracture, removing the locking wire allows the branches to spread in the metaphysis providing proximal stability. Distal locking is achieved through screw fixation.
The Marchetti-Vicenzi nail presents several theoretical advantages. Its flexible branches facilitate nail insertion and might favour fracture healing. Distal locking is performed under direct vision from posterior to anterior and additional proximal locking is not required, preventing iatrogenic neurovascular damage. Distal locking avoids nail migration and retrograde nail insertion spares the rotator cuff. Early mobilisation is often possible. This leads to an equally good elbow function, but with a better shoulder function compared to antegrade nailing.
On the other hand, limited rotational stability, especially in transverse fractures, can cause non-union and hardware failure. In the initial design, the bulky L-shaped end made a large supracondylar insertion and removal window mandatory, increasing the risk of fracture in this area. In the later version, the angle of the L-shaped cylinder has therefore been modified.
In our opinion, the use of the Marchetti-Vicenzi nail is not advisable in comminuted or transverse humeral fractures, in fractures extending in the distal third or in patients (young ladies) with a narrow medullary canal. Nail removal should only be considered if absolutely necessary.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
