INTRAMEDULLARY NAILING OF THE HUMERUS. CLINICAL OUTCOMES.

Abstract

During the last decade intramedullary nailing of the humerus became a more popular operation. Modern nails are successfully used in treatment of fractures involving proximal, distal and middle shaft humerus, as well as pseudarthrosis and pathological fractures. Minimal invasive insertion lessens the complications from neurovascular and soft tissue damage without significant delay in healing period in comparison with compression plates. Aim of our study is to present our experience and the clinical outcomes of this method.

Material and Methods: Between 1998 and 2006 50 patients (52 Fractured Hunerus) were treated in our department. The mean average age was 35 y.o. (18–55 y.o.) and the operation time was 2.5 days after the injury. All fractures were acute (Unstable, comminuted, in both limps or polytrauma patients). In 25 cases we used the unreamed Synthes nail (22 Cases Antegrade insertion and 13 Cases retrograde insertion). In 27 cases we used the T2 or Polarus reamed nail (23 cases Antegrade insertion and 4 cases retrograde insertion). The mean duration of the surgery was 1.3 h.

Results: The healing time was 12.5 weeks (8–16) and no preudarthrosis occurred. There were 4 radial nerve palsies (2 primary – 2 after operation) that were neuroapraxia and resolved in almost 6 weeks. One antegrade nail (Polarus-reamed) was malpositioned and applicated again and in 2 retrograde nails the posterior cortex of the fossa was fractured (in one case we changed fixation method-plates). No infection occurred. In some patients full abduction, elevation and external rotation achieved in 6 weeks and in some others after 3 months.

Conclusions: Intramedullary nailing of the humerus is a very good solution of fracture treatment, especially in multiple trauma patients. In good hands offers good fracture alignment and adequate stability. Postoperative rehabilitation period is short, uneventful healing is common and almost excellent results always appear.