Abstract
Purpose: Operative treatment of diaphyseal humeral fractures is indicated for transverse displaced fractures, pathological or impending fractures, non unions, fractures with radial nerve palsy and oblique fractures after conservative treatment failure.
Different techniques are available but many surgeons have recently expressed a preference for retrograde nailing. We present our results with new generation retrograde self-locking nail.
Methodology: From 1998 to 2004, we treated 112 patients with the cannulated retrograde EXP nail (LIMA LTO). All patient have been operated in the prone position on a conventional orthopaedic table.
Proximal locking, in this device, is obtained by the angled protrusion of a wire from the nail proximal extremity. Experimental tests in the lab have confirmed the excellent torsion stability of this mechanism.
Distally, the EXP nail has two little wings shaped to sit on the medial and lateral columns of the olecranic fossa and to thus provide an effective rotational and traction control.
We treated 67 traumatic fracture, 15 pathological fractures, 10 impending fracture and 20 a non-unions. 10 patients in this series were obese.
Results: Average surgical time was 40 minutes (min 30 – max 110). Average radiation exposure was 1 minute and 15 seconds (20 seconds for proximal locking).
Union was obtained in all the 67 primary fractures and stability was secured for all the impending and pathological cases. All but 1 non-union healed after an average of 2.6 months. In 2 patients of the primary fractures and in 3 patients of the non-union group we had a delayed union. The 3 non-union patients healed after 5, 7 and 9 months respectively. Overall 9 of the 10 obese patients healed. No patients suffered shoulder pain. In 8 cases a reduction of less than 10 degrees of elbow extension was detected. Forty-five nails have been removed so far after an average of 11 months after nailing. No major problems in nail removal have been encountered.
Conclusions: Retrograde nailing of the humerus presents significant advantages over other techniques and is meeting more and more consensus. The nail employed in this series provides satisfactory stability, it is cannulated and requires minimal radiation exposure.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
