English

Abstract

AIMS: The aim of our study was to find the difference between the mean duration of union and functional outcome between the dynamic compression plating (DCP) and the intramedullary interlocking nailing in diaphyseal fractures of the humerus in adults. MATERIALS AND METHODS: From January 2007 to December 2008, 34 patients with diaphyseal fractures of the humerus were treated with compression plating using dynamic compression plate or with intramedullary interlocking nail. The time taken for radiological union in the two groups was compared. After satisfactory radiological union, the functional outcome was assessed by the Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire. RESULTS: All fractures united and a marginal difference was noted in the time taken for union. The functional outcome was better in DCP group compared to interlocking nailing group which was statistically significant (P= 0.010). The complication associated with interlocking group was more than the DCP group. CONCLUSION: We are of the opinion that when surgery is opted as a choice of treatment, both the modalities of treatment i.e. dynamic compression plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the number of complications and functional outcome, we opine that dynamic compression plating offers better result than antegrade interlocking nailing with respect to pain and function of the shoulder joint. INTRODUCTION: Fractures of the diaphysis of the humerus and its complications are a major cause of morbidity in trauma patients. Fractures of the humeral shaft account for 20 % of the humeral fractures1 and about 3-5 % of all fractures2. Humeral fractures have a bimodal pattern in terms of age and sex of patients. The 1st peak is seen predominantly in young males in the age group 21-30 years mainly due to high energy trauma 2 . The 2nd peak in seen in females of age 60-80 years caused primarily due to simple falls 2 . Closed reduction is the mainstay of treatment of diaphyseal fractures of the humerus 3 . Operative treatment is required only if indicated2. Operative treatment commonly involves either plating or intramedullary nailing. The dynamic compression plate (DCP) is commonly used for plating and interlocking intramedullary nail is used for nailing. Closed intramedullary nailing is widely accepted for the stabilization of femur and tibia. Nowadays it is also being applied to the fractures of the humerus. Plate fixation gives high rates of union, but requires extensive open operation with stripping of soft tissues from the bone4. It also provides less secure fixation, especially in osteoporotic bone and if crutch walking is required. Closed intramedullary nailing avoids all these problems. Taking these points in mind, we undertook this study to compare these two modalities in the treatment of humerus fractures with respect to the mean duration for union & the functional