Introduction: We performed a clinical and radiological study to determine the functional outcome in terms of union and shoulder function and other related complications associated with treatment of humeral diaphyseal fractures with Intramedullary nailing.

Methods and Patients: A review of 100 consecutive humeral nailing over a period of four years performed solely for diaphyseal fractures using Russell Taylor nails.

51 male and 49 female.

Out of 100 nails, 90 were statically locked while 9 were locked proximally and 1 was locked only distally.

The outcomes were assessed clinically, radiologically and using the Disability of Arm Shoulder and Hand (DASH) function scoring system.

Statistically Cronbach’s alphas were calculated for the three scales of the DASH instrument. These scales were the function/symptom scale consisting of 30 items, sports/music module containing 4 items, and work module comprising 4 items.

Medians (interquartile ranges) and ranges are presented for numerical variables.

Mann-Whitney U tests (two-tailed) and Univariate and multivariate regression analysis were used.

Results: 90% fractures united initially and 4% had delayed union, giving cumulative union rate of 94%. Six non unions required a second procedure.

The DASH function scale scores was categorised into good 71 patients 85.5% (Score 0-< 25),

Medium 4 patients 4.8% (Score 25-< 40) and Poor 8 patients 9.6% (Score 40+).

Univariate and multivariate regression analysis showed, Increasing age (adjusted OR=0.96,95%CI 0.93–0.99,P< 0.01) and communited compared to simple fractures (adjusted OR=0.12,95%CI 0.03–0.45,P< 0.01) were associated with reduced likelihood of attaining full range of motion.

Male patients (unadjusted OR=2.37,95%CI 0.90–6.25,P=0.08) and patients involved in RTA compared to falls (unadjusted OR=4.5,95%CI 0.96–21.07,P=0.06) were associated with higher likelihood of attaining full range of motion.

85 % had no complication, while 15 % had complications.

One nerve palsy and one case of infection.

Seven patients required nail removal and 3 required removal of proximal locking screw.

Conclusion: To date, we have the largest series in the literature of antegrade nailing for diaphyseal fractures. In our series the vast majority of patients achieved desired functional outcome and union, hence we recommend the use of intramedullary nailing for humeral diaphyseal fractures. By eliminating surgical technique errors, complications can be reduced further and even higher union rates can be achieved.

Background: A common problem following total joint arthroplasty is urinary retention, which often necessitates catheterisation in the postoperative period. Most of these catheterisations are done as an emergency in the ward where the sterility is less than optimal.

Methods : A retrospective study of the incidence of emergency urinary catheterisation in 300 male patients who underwent total joint Arthroplasty under spinal anaesthesia over an eighteen-month period is presented. The patients were divided into three groups according to their age Group 1 (50 to 65 yrs), Group 2 (65 to 70 yrs) and Group 3 (70 + yrs).

Results: The incidence of catheterisation for acute urinary retention in Group 1 was 20%, Group 2 – 65% and Group 3 –69%.

Discussion: Urinary stasis predisposes to infection. The direct relationship between urinary catheterisation and infections in total joint Arthroplasty is already well documented. The potential for infection is compounded if the procedure is carried out in the unsterile ward environment. This study shows that the incidence of emergency catheterisation in patients aged 65 or above was high (average 67%) .

Conclusion: We conclude that these patients in groups 2 and 3 should be catheterised electively in the optimal sterile environment of the operating theatre. Catheterization should be performed after the patient has had the anaesthetic and the prophylactic intravenous antibiotic has been administered. The potential occurrence of joint and urinary tract infection is reduced and consequently patient morbidity is lessened.

Sciatic Nerve Palsy (SNP) is a recognised complication in Primary Total Hip Replacement after a transtrochanteric or a posterior approach (5). It is considered to be caused by direct trauma to the nerve during surgery. In our unit this complication was rare with an incidence of < 0.2% over the past ten years. However we know describe six cases of sciatic nerve palsy occurring in 355 consecutive primary THRs (incidence 1.60%) performed in our unit from June 2000 to June 2001. Each of these sciatic nerve palsies we believe was due to postoperative haematoma in the region of the sciatic nerve.

To our knowledge there are only five reported cases in the literature of sciatic nerve palsy secondary to postoperative haematoma (1). (Each of the six patients who developed SNP was receiving prophylactic anticoagulation).

Cases recognized early and drained promptly showed earlier and more complete recovery. Those in whom diagnosis was delayed and were therefore managed expectantly showed no or poor recovery. More than usual pain the buttock, significant swelling in the buttock region and sciatic nerve tenderness associated with signs of sciatic nerve irritation may suggest the presence of haematoma in the region of the sciatic nerve. It is therefore of prime importance to be vigilant for the signs and symptoms of sciatic nerve palsy in the early post operative period because if recognized and treated early the potential injury to the sciatic nerve may be reversible.