To evaluate the functional outcome of open humerus diaphyseal fractures treated with the Three-stitch technique of antegrade humerus nailing. This is a retrospective study conducted at the Department of Orthopaedics in D. Y. Patil University, School of Medicine, Navi Mumbai, India. The study included 25 patients who were operated on from January 2019 to April 2021 and follow-ups done till May 2022. Inclusion criteria were adult patients with open humerus diaphyseal fractures (Gustilo-Anderson Classification). All patients with closed fractures, skeletally immature patients, and patients with associated head injury were excluded from the study. All patients were operated on with a minimally invasive Three-stitch technique for antegrade humerus nailing. All patients were evaluated based on DASH score. Out of the 25 patients included in the study, all patients showed complete union. The mean age of the patients was 40.4 years (range 23–66 years). The average period for consolidation of fracture was 10.56 weeks (range 8–14 weeks). The DASH score ranged from 0 to 15.8 with an average score of 2.96. Five patients reported complications with three patients of post-operative infection and delayed wound healing and two patients with screw loosening. All complications were resolved with proper wound care and the complete union was noted. None of the patients had an iatrogenic neurovascular injury. Three-stitch antegrade nailing technique is a novel method to treat diaphyseal humerus fractures and provides excellent results. It has various advantages such as minimal invasiveness, minimal injury to the rotator cuff, fewer infection rates, minimal iatrogenic injuries, and good functional outcomes. Therefore, this treatment modality can be effectively used for open humerus diaphyseal fractures

The choice of whether to perform antegrade intramedullary nailing (IMN) or plate fixation (PF) poses a conundrum for the surgeon who must strike the balance between anatomical restoration while reducing elbow and shoulder functional impairment. Most humeral middle third shaft fractures are amenable to conservative management given the considerable acceptable deformity and anatomical compensation by patients. This study is concerned with the patient reported outcomes regarding shoulder and elbow function for IMN and PF respectively. A prospective cohort study following up all the cases treated surgically for middle third humeral fractures from 2016 to 2022 at a single centre. Telephonically an analogue pain score, an American Shoulder and Elbow Society (ASES) score for shoulder function and the Oxford Elbow score (OES) for elbow function were obtained. One hundred and three patients met the inclusion criteria. Twenty four patients participated in the study, fifteen had IMN (62.5%) and nine had PF (37.5%.). The shoulder function outcomes showed no statistical difference with an average ASES score of sixty-six for the IMN group and sixty-nine for the PF group. Women and employed individuals expressed greater functional impairment. Hand dominance has no impact on the scores of elbow and shoulder function post operatively. The impairment of abduction score post antegrade nailing was higher in the antegrade nailing group than the plated group. The OES demonstrated greater variance in elbow function in the PF group with the IMN group expressing greater elbow disfunction. This study confirms that treatment of middle third humerus shaft fractures by plate fixation is marginally superior to antegrade intramedullary nailing in preserving elbow function and abduction ability

Introduction. Coronal malalignment and leg length discrepancies (LLD) are frequently associated. Temporary hemiepiphysiodesis (tHED) is commonly employed for the correction of limb malalignment in skeletally immature patients. For treatment of LLD greater than 2 cm, lengthening with intramedullary legnthening nails is a safe and reliable technique. However, the combined application of these approaches in skeletally immature patients has not yet been investigated. Materials & Methods. Retrospective radiological and clinical analysis of 25 patients (14 females, 11 males) who underwent intramedullary femoral lengthening with an antegrade PRECICE® lengthening nail as well as tHED of the distal femur and / or proximal tibia between 2014 and 2019. tHED was conducted by implantation of flexible staples (FlexTack™) either prior (n = 11), simultaneously (n = 10), or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). Results. The median initial LLD was 39.0 mm (35.0–45.0). 21 patients (84%) presented valgus and 4 (16%) showed varus malalignment. Leg length equalization was achieved in 13 patients at skeletal maturity (62%). The median LLD of patients with a residual LLD > 10 mm was 15.5 mm (12.8–21.8). Limb realignment was obtained in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Conclusions. The combination of antegrade femoral lengthening and tHED can efficiently correct LLD and coronal limb malalignment in skeletally immature patients. Nevertheless, achieving limb length equalization and realignment may render difficult in cases of severe LLD and angular deformity. Furthermore, the reported techniques ought to be thoroughly planned and executed and require regular clinical and radiological examinations until skeletal maturity to avoid - or timely detect and manage - adverse events such as overcorrection and rebound of deformity

To quantify bone-nail fit in response to varying nail placements by entry point translation in straight antegrade humeral nailing using three-dimensional (3D) computational analysis. CT scans of ten cadaveric humeri were processed in 3D Slicer to obtain 3D models of the cortical and cancellous bone. The bone was divided into individual slices each consisting of 2% humeral length (L) with the centroid of each slice determined. To represent straight antegrade humeral nail, a rod consisting of two cylinders with diameters of 9.5mm and 8.5mm and length of 0.22L mm and 0.44L mm respectively joined at one end was modelled. The humeral head apex (surgical entry point) was translated by 1mm in both anterior-posterior and medio-lateral directions to generate eight entry points. Total nail protrusion surface area, maximum nail protrusion distance into cortical shell and top, middle, bottom deviation between nail and intramedullary cavity centre were investigated. Statistical analysis between the apex and translated entry points was conducted using paired t-test. A posterior-lateral translation was considered as the optimal entry point with minimum protrusion in comparison to the anterior-medial translation experiencing twice the level of protrusion. Statistically significant differences in cortical protrusion were found in anterior-medial and posterior-lateral directions producing increased and decreased level of protrusion respectively compared to the apex. The bottom anterior-posterior deviation distance appeared to be a key predictor of cortical breach with the distal nail being more susceptible. Furthermore, nails with anterior translation generated higher anterior-posterior deviation (>4mm) compared to posterior translation (<3mm). Aside from slight posterolateral translation of the entry point from the apex, inclusion of a distal posterior-lateral bend into current straight nail design could improve nail fitting within the curved humeral bone, potentially improving distal working length within the flat and narrow medullary canal of the distal humeral shaft

Background. The approach to Intramedullary (IM) fixation of long bone fractures remains a controversial issue. Early reports demonstrated less favourable results of retrograde nailing as compared with antegrade options due to higher non-union rates. The aim of this audit was to evaluate the outcomes of practice within the Trauma and Orthopaedic department with relation to IM nail fixation of diaphyseal femur fractures. Methodology. The Trauma database between February 2010 and September 2013 was used to identify all femur IM nailing procedures. Picture Archiving and Communication System (PACS) software was used to classify the fractures according to the Muller AO classification. All 3–2 (Diaphyseal femur fractures) were included in the audit. PACS imaging together with outpatient documentation was evaluated for radiological and clinical outcome. Results. A total sample size of 23 patients was identified (13 antegrade vs. 10 retrograde approach fixations). Mean patient age was 67 years and male to female ratios were similar (11M vs. 12F). Antegrade nailing was performed in a younger population as compared to retrograde nailing (mean age 60 vs. 73 respectively). Mean time to union was somewhat more protracted in the retrograde group (7 vs. 5 months), although all fractures united. The most common complication with relation to antegrade nailing was due to distal locking screws backing out. I case of infection was reported in the retrograde nail group, which was treated successfully with antibiotic therapy. There were 2 cases of nonunion observed in the antegrade group. Conclusions. The results of our practice were comparable to those published in recent literature. Overall, union rates for the two groups of fixation were similar. Each fixation technique is associated with its own specific set of complications. As a general rule antegrade nailing was reserved for a younger population so as to prevent trauma to the native knee joint

Introduction: Antegrade intramedullary locked nailing is a reliable method for the treatment of humeral shaft fractures. There is a still debate on the functional effect due to a possible damage during surgical approach of the rotator cuff, but in the Literature few paper deal with the analysis of tendons in these patients. Ultrasonography is still considered a reliable method in evaluating rotator cuff tendons. The aim of this study is to evaluate if antegrade intramedullary nailing may induce a possible damage on rotator cuff. Methods: Between May 2002 to December 2005 42 patient suffering of humeral shaft fractures were surgically treated with Unreamed Humeral Nail. Of them 21 (13 males and 8 female) were followed (average follow-up 22,9 months). All the fractures were traumatic except 1 due to bone metastasis of carcinoma. Follow up was clinical with Constant Score, radiographic in 3 projection (neutral, internal and external), and ultrasonographic, evaluating tendon of m. Sovraspinosus. Results: Healing of fractures was obtained after 2 month from surgery in all cases; Constant Score’s average was 77,0. Three cases of impingement syndrome due to excessive length of nail were observed, healed after the nail removal. Ultrasonography showed that in 13 cases rotator cuff was normal. In 5 cases we have found a signicative hyperecogen area, related to the scarf. We have never had a damage of tendon in all its tickness. Conclusion: Our study confirms that antegrade intra-medullary nail is a reliable method for the treatment humeral shaft fractures, not adversely influenced shoulder tendons. Damage of rotator cuff observed in few cases is not related to surgical technique, but depends on surgical pitfall with an excessively long nail and then impingement syndrome

The purpose of this project was to evaluate North American trauma surgeon preferences regarding patient positioning for antegrade fixation of mid shaft femoral shaft fractures. This project was a cross sectional survey taken of orthopaedic fellows and staff surgeons, belonging to three organizations across North America. An estimated sample size was calculated a priori, while various online techniques were utilized to reduce non responder and fatigue bias. The survey was distributed multiple times to optimize yield. Two hundred twelve (212) participants responded in full, 134 (56%) of whom practiced in Canada. The majority of surgeons worked in level one trauma centres (74%), while 72% treated more than one femoral shaft fracture per week. The most common patient position for mid shaft fixation amongst all surgeons was lateral positioning with manual traction (68%), however community surgeons were significantly more likely to use a fracture table. The most common difficulties faced with using a fracture table were inability to achieve fracture reduction and peroneal nerve palsies. The majority (64%) of surgeons quoted a complication rate with fracture tables of greater than 1 per 100 cases. Lateral position with use of manual traction is the preferred set up for antegrade fixation of femoral shaft fracture in this large North American cohort of trauma surgeons. However, a large subset of community and non academic surgeons still prefer use of the fracture table. Amongst all respondents, a high rate of fracture table complications, including malreduction, were quoted. To date, there is no prospective data comparing these two options for patient positioning, and a randomized controlled trial may be an appropriate next step

Aim. We present the long-term surgical outcomes, complications, implant survival and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. Patients and Methods. A cohort of 50 consecutive patients who underwent the modified Harrington procedure along with cemented THA for peri-acetabular metastasis or haematological malignancy between 1990 and April 2018 were studied. The median follow-up time for all patients was 14 years (interquartile range, 9 – 16 years). Results. The 5-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at 5 and 10 years respectively. Eight patients survived beyond 5 years. There was no immediate peri-operative mortality or complications. Fifteen late complications occurred in 11 patients (22%). Five (10%) patients required additional surgeries to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status improved in 83%. Conclusions. The modified Harrington procedure for acetabular destruction showed low complication rates, good functional outcome and improved pain relief in selected patients. Long-term results are acceptable in this high risk group of patients. The described procedure using antegrade fully threaded large diameter pins combined with standard arthroplasty showed low rates of complications in this high risk cohort of patients with significant improvement in mobility and pain. This method of reconstruction remains robust for at least 5 years in appropriately selected group of patients

Antegrade intramedullary nailing via a piriformis fossa start point is the treatment of choice for most femoral shaft fractures in adults. Recently alternate approaches for intramedullary nailing of the femur have been advocated, including retrograde nailing and trochanteric start point antegrade nailing. Reasons cited for considering altenative starting points to the piriformis fossa include a concern about the damage to the hip abductor muscles that may occur during access to the piriformis fossa. There is very little literature about long- term muscle function after standard antegrade intramedullary nailing and the conclusions of the available studies are conflicting. The purpose of this study was to document the hip abductor muscle strength following standard antegrade intramedullary nailing utilizing two different objective measures (KinCom and gait analysis). Objective evidence of hip abductor muscle strength will assist in planning new nailing techniques. Twenty-two patients with isolated femoral shaft fractures who were treated with standard antegrade reamed interlocking intramedullary nailing and who had a minimum one year follow-up were identified. The patients were examined for muscle strength, range of motion and limb length. All of the patients answered a questionnaire and completed the SF-36 and Musculoskeletal Functional Assessment outcome measures. All patients had isokinetic muscle testing of their hip abductors, hip extensors and knee extensors using the KinCom muscle testing machine. Ten of the patients also underwent formal gait lab analysis. Isokinetic muscle testing showed no significant difference from the uninjured contralateral side in hip abduction, hip extension or knee extension. The gait lab analysis failed to show any important changes in gait pattern. SF-36 scores were comparable to norms. MFA scores did not indicate any significant long term disability. Antegrade reamed interlocking intramedullary nailing of femoral shaft fractures utilizing a standard piri-formis fossa starting point is not associated with any significant long term hip abductor muscle strength deficit. Gait pattern returns to normal following femoral shaft fracture treated with this technique and functional outcomes are good

Introduction: Twenty-four proximal humeral fractures were treated by surgical internal fixation with locked antegrade intramedullary nail. The purpose of this paper was to assess the clinical outcomes after treatment with antegrade humeral nail inplanted with an interval rotator split. Material and Methods: We present a consecutive series of 24 patients with proximal and diaphyseal humeral fractures treated with the Telegraph. ®. nail inserted trough the interval rotators. There were six proximal, seven bifocal interesting the third proximal and shaft and eleven diaphyseal humeral fractures fracture. Results: The mean follow-up was 22 months with a range from 12 to 32 months, nineteen of the 24 patients were available for follow-up. All but two fractures progressed to healing. The mean Constant score were 80, Relative Constant score were 94,6%. Conclusion: Intramedullary antegrade nail insert trough the interval rotator without violating rotator cuff results in good clinical outcomes and with certain fracture types can be an effective and satisfactory device

Aim: To evaluate time of union and functional recovery of the shoulder joint in humeral shaft fractures treated with antegrade intramedullary nailing. Methods: During 1998–2002, 29 patients (16 male and 13 female, mean age 43.7 years) with humeral shaft fractures underwent antegrade, proximal locked, intramedullary nailing. A modified extra-articular entry point, 1 cm below the greater tuberosity, was used to avoid rotator cuff damage. The nail, after accurate measurement of its length and proximal metaphysis enlargement up to 10 mm, was impacted into the narrow, cone-shaped, distal part of the humerus, without the necessity of distal screw interlocking. Passive motion of the shoulder joint was initiated from the 2nd postoperative day and active assisted exercises after the 2nd postoperative week. Results: Mean follow up period was 27 months. Solid callus formation was noted in all fractures, between the 14th and 18th postoperative week. No cases of intra-operative fractures, nerve irritation, rotational instability, nail migration and loss of distal impaction were noted. Mean Constant-Murley score was 93 points at the 16th postoperative week. Conclusion: Antegrade intramedullary nailing is a reliable and beneficial procedure for the treatment of humeral shaft fractures, regarding union and functional recovery of the arm. The extra-articular entry point should be preferred to avoid rotator cuff and articular surfaces damage whereas the accurate measurement of the nail length and the firm impaction of it at the olecranon fossa makes distally interlocking unnecessary, decreasing significantly the overall operative time and the associated complications

Purpose: To evaluate the assumption that reaming is the main reason for problems of shoulder function (pain – restricted range of motion) after antegrade intramedullary nailing of humerus (unless impingement of fixation material on the rotator cuff or acromion occurs). Materials – Methods: From January 1999 until March 2003 55 patients underwent unreamed antegrade intra-medullary nailing for treatment of recent fractures of the humeral shaft. Two different intramedullary nailing systems were used, that do not protrude from the humeral shaft and that do not require reaming for insertion. Patients with concomitant problems or complications that could affect the final functional result were excluded from the study (e.g. multiple injuries, brachial plexus lesions, etc.). The remaining 32 patients were examined for postoperative pain and functional problems in the shoulder joint. Results: No patient complained of persistent shoulder pain. Range of motion was found comparable to that of the other shoulder. Conclusions: Reaming seems to exert a harmful influence on the rotator cuff, due to direct injury caused by the reamers as they are inserted and withdrawn from the humeral head. Furthermore it is possible that bone reaming products, accumulating under the rotator cuff, contribute to the persistence of pain and loss of motion

Our objective was to investigate the adequacy of the antegrade intramedullary nailing for the treatment of proximal and distal humeral fractures. From January 2004 to April 2008, 28 proximal humerus fractures and 9 distal humerus fractures were treated with intramedullary nailing. Mean age of the patients was 69-year-old (39–82). 26 patients were males. All fractures of the first group were treated with closed static intramedullary nailing whereas in the second group closed static intramedullary nailing was achieved in 7 fractures. The clinical and radiological outcomes were evaluated. All the proximal humerus fracture – but one – obtained bone-union at an average of 3 months (from 2 to 4 months). The mean follow up was 22 months (6–40). Functional outcome measured by Constant score showed 22 patients with an excellent and good result and 6 with a poor result. One case with osteonecrosis of the humeral head was recorded. Malunion of the greater tuberosity was recorded in 7 fractures. Only 5 distal humerus fractures united at an average of 5 months (from 4 to 7 months). Functional outcome measured by Burri – Lob score showed 3 patients with an excellent and good result and 6 with a poor result. Failure of the distal locking was noticed in 5 patients and 3 fractures united in valgus position. The antegrade closed intramedullary nailing is an effective treatment method for the proximal humerus fractures. However the role of the nailing for the distal humerus fractures is humeral nail is effective for the treatment of proximal humeral fractures remains

AIM: The purpose of this prospective study was to asses the outcome of antegrade intramedullary wiring of displaced distal end of fifth metacarpal fracture in skeletally immature. Intramedullary wiring for fracture metacarpals have been well described in the literature. Retrograde wiring for neck of metacarpal fractures have been associated with limitation of extension at metacarpo-phalangeal joint due to involvement of gliding extensor mechanism. Foucher described ‘Bouguet’ osteosynthesis with multiple wires for metacarpal neck fracture which can be technically demanding in small bones of children. We describe an antegrade wiring using a single bent K-wire at the tip for reducing and stabilising displaced metacarpal neck fracture by rotating 180 degree after crossing fracture site, a method similar to Methaizeau technique for stabilisation of displaced radial neck fractures using nancy nail. METHOD: Between 2000 to 2006 we treated 9 boys with displaced distal end of fifth metacarpal fracture +/− rotational deformity of little finger using above technique. All of them had closed injuries and the indication for surgery was rotatory mal-alignment or fracture angulation more than 40 degrees. The assessment involved a clinical and radiological examination. The mean age was 13 years. The mean follow-up was 15 months. RESULTS: All fractures healed in anatomical alignment. There was no loss of active or passive movement of the little finger metacarpo-phalangeal joint or weakness of grip strength in any children. All children returned to pre-injury activity level within 4–6 weeks. There were no complications. CONCLUSION: Early results of treating displaced little finger metacarpal neck fracture in children using antegrade intramedullary wire are encouraging

Introduction: Intramedullary fixation is a recognised method of fracture fixation in fifth metacarpal fractures. We describe a new technique for fixation of fractures of the middle three metacarpals. Patients and Methods: We reviewed a single surgeon’s series of 16 male patients (mean age 27.9 years, range 18–46) with 20 displaced transverse midshaft fractures of the 2nd, 3rd and 4th metacarpals treated by antegrade intramedullary Kirschner wiring. Work related and domestic accidents constituted the mode of injury in 8 patients and in the remaining 8 as a result of an assault, fall or road traffic accident. Twelve patients were in employment at the time of injury including four heavy manual labourers. A single pre-bent 1.6 millimetre Kirschner wire was inserted into the medullary canal through a drill hole in the metacarpal base and passed across the reduced fracture into the metacarpal head. The proximal end of the wire remained protruding percutaneously. Following stabilisation of the fracture, early mobilisation was commenced. Results: All of the study group had satisfactory clinical and radiological outcomes. All of the fractures united clinically and radiologically. There was one case of delayed union, with union at 35 weeks. In the remaining patients fracture union had occurred radiologically at an average of 5.4 weeks (range 4–12 weeks). Radiologically there was a mean angular deformity of 4.05° (range 0–11°) in the coronal plane and 0.75° (range 0–9°) in the sagittal plane. Postoperatively 2 patients developed a pin tract infection requiring treatment with antibiotics and early removal of the K-wire. All patients on questioning by telephone questionnaire were satisfied with their resulting hand function and appearance. All patients had returned to normal activities of daily living by 8 weeks. Of those patients in employment all had returned to work by 6 weeks (mean 3.3. weeks). Conclusion: Antegrade intramedullary single K wiring is a useful technique for managing unstable midshaft metacarpal fractures producing excellent clinical and radiological results

Introduction and Aims: Recently alternate approaches for intra-medullary femoral nailing have been advocated, including retrograde nailing and trochanteric start point antegrade nailing in an attempt to avoid damage to the hip abductor muscles that may occur during access to the piriformis fossa. The aim of this study was to document the hip abductor muscle strength following standard antegrade intra-medullary nailing utilising two different objective measures. Method: Twenty-two patients with isolated femoral shaft fractures who were treated with standard ante-grade reamed interlocking intra-medullary nailing and who had a minimum one-year follow-up were identified. The patients were examined for muscle strength, range of motion and limb length. All of the patients answered a questionnaire and completed the SF-36 and Musculoskeletal Functional Assessment outcome measures. All patients had isokinetic muscle testing of their hip abductors, hip extensors and knee extensors using the KinCom muscle testing machine. Eleven of the patients also underwent formal gait lab analysis. Results: Isokinetic muscle testing showed no significant difference from the uninjured contralateral side in hip abduction, hip extension or knee extension. The gait lab analysis failed to show any important changes in gait pattern in the time spatial and hip moment parameters. SF-36 scores were comparable to norms (mean physical component score 53 and mean mental component 51). MFA scores did not indicate any significant long-term disability. Conclusion:Antegrade reamed interlocking intra-medullary nailing of femoral shaft fractures utilising a standard piriformis fossa starting point is not associated with any significant long-term hip abductor muscle strength deficit. Gait pattern returns to normal following femoral shaft fracture treated with this technique and functional outcomes are good

In a prospective study from October 2002 to December 2003, we evaluated 102 femoral fractures treated with the new Synthes antegrade femoral nail. It is a titanium femoral nail with a recon locking option, distal dynamisation slot and trochanteric entry point. There were 99 patients (76 males and 23 females), three of whom had bilateral fractures and 42 polytrauma. The mean age was 36 years (13 to 87). The mean Injury Severity Score was 42 (23 to 65). Motor vehicle accidents were the cause of 44 fractures and gunshot injuries the cause of 37. There were 25 transverse fractures (AO 32-A), 37 wedge type fractures (AO 32-B) and 40 complex (AO 32-B) fractures. There were 38 Gustilo type-II and type-III open fractures. Surgery was performed within 24 hours in 80% of the fractures. Nine required open reduction. Unreamed nails were inserted in 38 patients. All fractures united. However, 11 showed angulations greater than 5°. Two patients had shortening of more than 1 cm, one of them requiring reoperation. One patient sustained a iatrogenic fracture, four developed fat embolism syndrome and three had DVT. Three patients had early superficial wound infection and two had late infections with a draining sinus. One locking screw broke. We found this to be a reliable femoral nail with a safe entry point

Introduction. To compare the union rates and post-operative mobility of antegrade intramedullary nailing of osteoporotic traumatic supracondylar femoral fractures (AO classification A to C2) with those of plating. Materials/Methods. We studied any traumatic intra or extra-articular supracondylar femoral fracture from 2005–2010. Patients were either admitted directly to our level 1 trauma centre or were referred from another hospital. Nineteen patients were identified, consisting of primarily fixation with five antegrade nails and fourteen plates. We defined osteoporotic bone as being present in anyone over sixty years old or who had a clinical diagnosis. One nail and six plates were excluded due to young age or fracture severity. This left four nails, six less invasive stabilisation system plates and two dynamic condylar screw plates. Both groups were comparable with respect to age, sex and AO fracture classification. Results. There was a significant difference in achieving union between the two groups (p=0.040). Union occurred within three months in all four fractures in the nail group but only three fractures (38%) united after primary fixation in the plate group. There were two failures due to screw pullout, one failure due to screw breakage, one broken plate after delayed-union and one screw breakage after non-union. The patients in the nail group had better mobility and less pain than the plate group but the difference was not statistically significant. Conclusion. We have shown that for patients with osteoporotic, supracondylar femoral fractures, fixation with an antegrade IM nail provides significantly better healing compared to plate fixation

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

Proximal humerus fracture treatment remains controversial. If the conservative treatment is widely accepted for Neer I and Neer II fractures, the attitude is not very clear concerning Neer III and Neer IV fractures. Several methods are proposed in the literature varying from suturing, pinning or plating the proximal humerus. Hemiarthroplasty are even considered. In our study we present our results of an internal fixation procedure for 3 part or 4 part fractures of the upper part of the humerus. Material and Methods: Antegrade nailing with self stabilizing screws, by T2 nail, is used in 13 patients treated between January 2004 and December 2005. Average age is 81 years old. The medial insertion technique is used because of the greater tuberosity fracture. Clinical and radiological data were available for the 13 patients with a mean follow up of 19 months. Functional outcome is assessed using the Visual Analog Scale (VAS) and the Constant Score. Results: At last follow up, most of the patients are satisfied with their operation with a mean VAS of 2.46 and a mean Constant Score of 64.7. Mean antepulsion was 148° while mean abduction was 136°. No infection was reported. There are 4 cases of greater tuberosity necrosis without influence on the rotator cuff muscles. One case of head necrosis is signaled. Discussion: Complex fractures of the proximal humerus remain a challenge for the orthopedic surgeons. To date, there is non agreement on the most appropriate osteosynthesis method and the results of shoulder arthroplasty or proximal plating remain controversial. The T2 nail appears to be a simple and reproducible method of achieving reduction, stability and early mobilization. It is an attractive alternative to shoulder prosthesis or proximal plating in trauma victims with complex displaced fractures