DOES CLOSED INTRAMEDULLARY INTERLOCKING NAILING IN PATIENTS WITH HUMERAL SHAFT FRACTURES HAS ADVANTAGES: EVALUATION THROUGH A CLINICAL STUDY

Sai Pavan Kumar Murari; Nagam Kirthi Chandra; Anirudh Phani Bhargav K; Shanthan Reddy Palvai

doi:10.22159/ajpcr.2017.v10i3.16439

Authors

Sai Pavan Kumar Murari Department of Orthopedics, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India.
Nagam Kirthi Chandra Department of Orthopedics, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India.
Anirudh Phani Bhargav K Department of Orthopedics, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India.
Shanthan Reddy Palvai Department of Orthopedics, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India.

DOI:

https://doi.org/10.22159/ajpcr.2017.v10i3.16439

Keywords:

Fracture shaft humerus, Functional outcome, Intramedullary interlocking nail fixation, Nonunion, Shoulder stiffness, Superficial infection

Abstract

Objective: Intramedullary interlocking nail fixation (IINF) for the fracture shaft humerus (FSH) offers good clinical outcome. Evaluating the functional
outcome of IINF in FSH and assessing the complications of the technique, time taken for fracture consolidation, and union rates were the objectives.

Methods: Adult patients with a clinical diagnosis of diaphyseal fracture of humerus were assessed clinically and radiologically for the functionalÂ outcome of IINF in FSH. Functional outcome of shoulder and elbow considered together was graded as excellent, moderate, and poor. Daily assessmentÂ was done along with active physiotherapy. All were followed up at monthly intervals for 6-12 months or till the union of fracture. RadiologicalÂ assessment was done at immediate post-operative period, at months 1, 3, 6, 9, and 12 months.

Results: 30 patients (males n=24, 80%) with a mean(Â±standard deviation) age of 39(Â±13.31) years were included. Road traffic accident was theÂ frequent cause (n=18, 60%). Indirect injury was the cause in 66.66% patients. Middle 1/3rd of shaft of humerus was fractured in 53.33% patients.Â 10 (33.3%) patients each had oblique fracture and transverse fracture, respectively; comminuted fracture was seen in another 26.6% patients. RadialÂ nerve palsy (10%) was the frequent associated injury of the total nine. The overall functional outcome was excellent in 80%, moderate in 16.6%, andÂ poor in 3.3% patients. Postoperatively, nonunion, superficial infection and shoulder stiffness was seen in one patient each.Â Conclusion: IIFN is an excellent, least invasive surgical option for FHS with early fracture consolidation and better union rates.

Keywords: Fracture shaft humerus, Functional outcome, Intramedullary interlocking nail fixation, Nonunion, Shoulder stiffness, Superficial infection.

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References

Balfour GW, Mooney V, Ashby ME. Diaphyseal fractures of the humerus treated with a ready-made fracture brace. J Bone Joint Surg Am 1982;64(1):11-3.

Thakur AJ. The Elements of Fracture Fixation. (eBook). 2nd ed. New Delhi: Elsevier India; 2007.

Asian J Pharm Clin Res, Vol 10, Issue 3, 2017, 434-438

Murari et al.

Sahu RL, Ranjan R, Lal A. Fracture union in closed interlocking nail in humeral shaft fractures. Chin Med J (Engl) 2015;128(11):1428-32.

Chandler RN. Principles of internal fixation. In: Rockwood CA Jr, editor. Rockwood and Greenâ€™s Fractures in Adults. 4th ed., Vol. 1. Ch. 3. Philadelphia, PA: Lippincott-Raven; 1996. p. 159.

Rommens PM, Verbruggen J, Broos PL Retrograde locked nailing of humeral shaft fractures. A review of 39 patients. J Bone Joint Surg Br 1995;77(1):84-9.

Kesemenli CC, Subasi M, Arslan H, Necmioglu S, Kapukaya A. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc 2003;37(2):120-5.

Ozturkmen Y, Dogrul C, Dogan A, Karli M. Locked intramedullary nalllng of humeral shaft fractures. Ulus Travma Derg 2002;8(3):164-9.

Crates J, Whittle AP. Antegrade interlocking nailing of acute humeral shaft fractures. Clin Orthop Relat Res 1998;(350):40-50.

Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma 1998;44(5):859-64.

Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weight bearing on plated fractures of the humeral shaft. J Trauma 2000;49(2):278-80.

Kelsch G, Deffner P, Ulrich C. Seidel humerus intramedullary nailing. Clinical results of 100 surgeries. Unfallchirurg 1997;100(2):111-8.

Marty B, KÃ¤ch K, Friedl HP, Trentz O. Intramedullary nailing of the humerus shaft fracture. Unfallchirurg 1994;97(8):424-9.

Durbin RA, Gottesman MJ, Saunders KC. Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res 1983;(179):168-74.

Jensen CH, Hansen D, JÃ¸rgensen U. Humeral shaft fractures treated by interlocking nailing: A preliminary report on 16 patients. Injury 1992;23(4):234-6.

Brumback RJ, Bosse MJ, Poka A, Burgess AR. Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg Am 1986;68(7):960-70.

Dabezies EJ, Banta CJ 2nd, Murphy CP, dâ€™Ambrosia RD. Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries. J Orthop Trauma 1992;6(1):10-3.

Marty B, KÃ¤ch K, Candinas D, Friedl HP, Trentz O. Results of intramedullary nailing in humerus shaft fractures. Helv Chir Acta 1993;59(4):681-5.

Riemer BL, Butterfield SL, Dâ€™Ambrosia R, Kellam J. Seidel intramedullary nailing of humeral diaphyseal fractures: A preliminary report. Orthopedics 1991;14(3):239-46.

Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am 1986;68(3):430-3.

Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail stabilization of humeral shaft fractures. J Orthop Trauma 1992;6(1):18-24.

Hall RF Jr, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am 1987;69(4):558-67.

Robinson CM, Bell KM, Court-Brown CM, McQueen MM. Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period. J Bone Joint Surg Br 1992;74(4):558-62.

Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br 1985;67(2):293-6.

Petsatodes G, Karataglis D, Papadopoulos P, Christoforides J, Gigis J, Pournaras J. Antegrade interlocking nailing of humeral shaft fractures. J Orthop Sci 2004;9(3):247-52.

Foster RJ, Dixon GL Jr, Bach AW, Appleyard RW, Green TM. Internal fixation of fractures and non-unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surg Am 1985;67(6):857-64.

Rodriguez-Merchan EC. Hackethal nailing in closed transverse humeral shaft fractures after failed manipulation. Int Orthop 1996;20(3):134-6.

Stern PJ, Mattingly DA, Pomeroy DL, Zenni EJ Jr, Kreig JK. Intramedullary fixation of humeral shaft fractures. J Bone Joint Surg Am 1984;66(5):639-46.

Babin SR, Graf P, North J, Schvingt E. Infection following closed intramedullary nailing by Kuntscherâ€™s method in 1059 fractures. Int Orthop 1981;5(4):271-6.

Ikpeme JO. Intramedullary interlocking nailing for humeral fractures: Experiences with the Russell-Taylor humeral nail. Injury 1994;25(7):447-55.

KrÃ¶pfl A, Naglik H, Niederwieser B, Hertz H. Unreamed antegrade humeral interlocking nailing. Unfallchirurg 2000;103(5):348-54.