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.

Introduction: Graft selection for anterior cruciate ligament (ACL) reconstruction remains controversial. The use of hamstring graft is associated with less harvest site morbidity but concern has been expressed with tibial fixation for these grafts. We recently began to use the new Intrafix^TM ACL tibial fastener with hamstring grafts. It claims greater pullout strength and greater graft contact with circumferential healing of the tendons to the bone tunnels. Our objective was to assess the short term functional results with the new fixation as well as donor site morbidity.

Methods: We reviewed 64 patients who had a primary ACL reconstruction (quadrupled semitendinosus and gracilis tendons with Endobutton^TM femoral fixation) performed at least six months previously. They were assessed using self-administered International Knee Documentation Committee (IKDC) knee evaluation forms and the Lysholm knee score.

Results: The average patient age was 25 years (range 16–49 years) with average follow-up of 10.5 months (range 7–15 months). There were 57 males and 7 females. Forty two patients returned the questionnaires and 26 patients returned for examination. Over half of the patients (38/64) had meniscal tears. The mean IKDC score was 82.6 (SD 13.0) and the mean Lysholm score was 85.0 (SD 12.6). Sixty nine percent of patients (29/42) had knees rated excellent or good using the Lysholm knee score. Eighty eight percent (23/26) of the patients examined had normal or nearly normal knee function as graded by the IKDC. No patient had anterior knee numbness. Four patients had arthroscopic debridement and washout for knee pain and two patients had a wound haematoma at the donor site.

Conclusions: The Intrafix^TM ACL tibial fastener provides sufficient early fixation to allow patients undergo a standard accelerated rehabilitation regime, leading to good functional recovery at 6 months. Our choice of ACL graft also results in low donor morbidity.

Introduction: The management of humeral diaphyseal fractures is in a state of flux, with humeral plating becoming more popular than humeral nailing. This change of opinion has been stimulated primarily by the American literature, which quotes significant complication rates associated with humeral nailing.

Methods: We undertook a retrospective study, over a consecutive seven year period, to evaluate the complication rate and the functional outcome (American DASH scoring system) following humeral nailing. The study group was composed of 91 patients, with an average age of 50 years (22–90). All cases were performed by a consultant or under their direct supervision. The minimum follow-up was one year.

Results: Of the 91 cases, 7 were lost to follow-up. Non-union was seen in 4 cases, all requiring removal of nail with additional surgical procedures. Delayed union was seen in 2 cases. Nail prominence causing impingement pain was seen in 4 cases, necessitating nail removal. In 3 cases, the proximal screws loosened and in 1 case the distal screw loosened, necessitating removal. One case required an exchange nailing to improve stability and one nail became infected, again demanding removal. Thus significant complications were seen in 16 of 84 (19%) cases. The functional outcome was good to excellent in 51 cases and poor to moderate in 33 cases.

Conclusion: Based on our results, we agree with the current move away from humeral nailing as the procedure of choice for humeral diaphyseal fractures. We are supportive of the move towards humeral plating.