ANTEGRADE VS. RETROGRADE INTRAMEDULLARY HUMERAL NAILING – SHOULDER AND ELBOW FUNCTION, UNION RATES, COMPLICATIONS

Abstract

Introduction: Intramedullary nailing of the humerus for the treatment of diaphyseal fractures can be done through both extremities of the bone. The aim of the authors is to evaluate the positive and negative aspects of both techniques, evaluating postoperative shoulder and elbow function, union rates and complications.

Material and methods: Retrospective analysis with a maximal regression of 58 months, of patients submitted to surgical management of diaphyseal humeral fractures with intramedullary nailing (locked nails). Two different approaches were applied – antegrade and retrograde. The AO classification was utilized. Clinical evaluation of the shoulders was done using the Constant score and VAS. The elbows were evaluated using the Mayo Elbow Performance Score (MEPS) and VAS. The shoulder, humerus and elbow were radiologically evaluated. Patient satisfaction and re-intervention rates were also evaluated.

Results: 27 patients were surgically treated (21 males and 6 females). Age varied from 16 to 77y (average 48y). AO type 12.B2 fractures were more common. Motor vehicle accidents were the most common mechanism of injury. Two patients presented with radial nerve injury, one being iatrogenic (during placing of the distal screw in antegrade intramedullary nailing). Union rate was near 90%. In the medium term there were no significant differences between the MEPS and Constant score of the operated and non-operated upper limbs. Patient satisfaction was high in both types of approaches, There were no vascular lesions or infections.

Discussion and Conclusion: Retrospective analysis, with an acceptable sample and follow up period. Both surgical techniques are effective in the treatment of humeral diaphyseal fractures and have a low complication rate. In this study there were no significant differences in function between the operated and non-operated limbs