OPERATIVE TREATMENT OF HUMERAL SHAFT FRACTURE – INTERLOCKING NAILING VERSUS PLATING

Abstract

Objectives: To evaluate and compare the results of interlocking nailing (ILN) and plating (PL) in fresh humeral shaft fractures (HSF)

Material and Methods: During 7 years period 145 patients with HSF (84 males and 61 females) were operated and followed up for 8 – 60 months (mean 18 months). According to AO there were 64 Type A, 53 Type B and 28 Type C fractures. Of 18 open injuries there were 10 grades I, 5 grades II and 3 grades IIIA. There were 33 patients with polytrauma, 11 cases with associated limb injuries, 9 cases with floating elbow and 22 patients with primary neurological deficit. In 75 fractures ILN was performed and PL in rest 70.

Results: The mean operative time was 85 min for ILN vs./117 min for PL and the mean blood loss 100ml vs./250 ml. Healing occurred in 139(95.6%) fractures with mean healing time 75 days vs./85 days. Functional results according to Rommens score were as follows. Shoulder: excellent 62(82.6%) vs./55(78.5%), good 11(14.6%) vs./11(15.7%), poor 2(2.8%) vs./4(5.8%).

Elbow: excellent 69(92%) vs./52(74.3%), good 6(8%) vs./16(22.8%), poor 0 vs./2(2.9%). Complications noted were iatrogenic nerve palsy 1(1.3%) vs./12(17%), delayed union 5(7%) vs./2(3%), non union 1(1.3%) vs./5(7%), infection 0 vs./1(1.4%), fixation failure 1(1.3%) vs./5(7%) and reosteosynthesis 1(1.3%) vs./1(1.4%), shoulder impingement 8(11%) vs./2(3%).

Conclusions: Interlockimg nailing reduces risk of nerve injury and infection, provides more stability in segmental, complex and osteoporotic HSF. No significant differences in the term of healing in the both methods. Plating should be preferred in open Fx with incidental nerve palsy or vascular injury and juxtaarticular Fx, especially distally located. The method provides anatomical reduction, but requires extended approach and increases risk of iatrogenic nerve palsy.