Experiences with the Russell-Taylor Nail in Humeral Shaft Fractures - An Analysis of Postoperative Results and Complications

Abstract

Besides conservative therapy we see an increasing number of humeral shaft fractures treated with osteosynthesis by means of an intramedullary nail. The major advantage of intramedullary stabilisation is the possibility of early physical rehabilitation and increased patient comfort. Between August 1994 and March 2000 we treated 56 acute humeral shaft fractures, 3 pathologic fractures and 3 humeral non-unions with the dynamic interlocking Russell-Taylor nail. The majority of nails were inserted using the anterograde insertion technique. We were able to follow-up 44 patients. The Constant score was evaluated as the key follow-up parameter. Main postoperative complications were 1 superficial wound infection at the insertion site of the nail, 3 transient radial nerve palsies, 3 secondary fractures and 4 non-unions. In 2 cases we noted mechanical irritation of the soft tissue due to the nail itself or the locking bolts. The overall side-comparing difference in the Constant score was 7.9 points (91.0 points versus 83.1 points at the injured side). This difference was basically due to a loss of 5.9 points in the category shoulder motion. Inner rotation of the humerus was the most impaired movement with a loss of 2.5 points. We conclude that the treatment of humeral shaft fractures with the intramedullary interlocking Russell-Taylor nail is a surgical procedure with less complications. In our study we found good to excellent functional outcome with a low rate of infections. For the treatment of short oblique or transversal humeral shaft fractures intramedullary nailing systems with static interlocking and the possibility to apply interfragmentary compression seem to be the superior treatment technique to reduce the rate of non-unions.