Antegrade Intramedullary Nailing in Humeral Shaft Fractures

Abstract

Purpose: To evaluate union time and functional recovery of the shoulder joint in humeral shaft fractures treated with intramedullary nailing. Material and Methods: During the period 1990-2001, 43 patients with humeral shaft fractures were treated with intramedullary nailing. 38 patients (21 males and 17 females, mean age 48 years) were available at the final follow-up evaluation after 21 months on average. In 25 patients the entry point was below the greater tuberosity to avoid rotator cuff injury and in the other 18 patients the entry point was intra-articular. Passive shoulder and elbow motion was allowed from the second postoperative day followed by active assisted exercises from the second postoperative week. Union progress was assessed radiologically at 2nd, 4th, 8th, and 16th postoperative week whereas final shoulder function was evaluated using the parameters of the Constant-Murley scoring system. Results: Solid callus formation was noted in all fractures, except one, between the 8th and 35th postoperative week. Patients with extra-articular application of the nail had full passive shoulder motion between the 2nd and the 4th postoperative week whereas patients with intra-articular application had delayed passive shoulder motion and final functional limitation. Seven patients had painful shoulder motion 3 months postoperatively. There were 4 patients with transient radial nerve palsy, who demonstrated full functional recovery after 3 to 6 months and 3 patients with proximally migration of the nail underwent reoperation. Conclusions: Intramedullary nailing in humeral shaft fractures seems to be a reliable method of treatment regarding union and functional recovery. Advantages are shorter operative time, minor blood loss, small incision with shorter soft tissue detachment and early mobilization of the shoulder, especially in the patients with extra-articular nail application without rotator cuff injury.