Grafting may effect the outcome in diaphyseal fractures of the humerus

Abstract

Dear Editor, We have read the article entitled “Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study.” with great interest [1]. In their study, the authors compared the results of the humerus intramedullary nail (IMN) in 23 patients and the dynamic compression plate (DCP) in 24 patients for the management of diaphyseal fractures of the humerus. The patients were randomised into 2 groups prospectively and treated by open reduction and internal fixation technique. In their study, inclusion criteria were grade 1 or 2a compound fractures, polytrauma, early failure of conservative treatment and unstable fractures. Exclusion criteria were patients with pathological fractures, grade 3 open fractures, refractures and old neglected fractures. We would like to ask some questions of the authors regarding their study. Why was it necessary to use autograft for the treatment of these fresh fractures according to the inclusion criteria? Did using autograft (7 patients in DCP group, 12 patients in IMN group) affect the result? How did they randomise the patients, because some fractures need autograft others not? Were there any patients treated by using autograft in the nonunion group, because grafting may change the final outcome (fracture healing)? In the Results section, there were 3 patients with nonunion in both groups, but in the Discussion section, there were 2 patients with different percentages of nonunion compared to the Results section. Which is the correct one? In the Discussion, McCormack RG et al. was cited as Reference 15. But in the Reference list McCormack RG et al. was cited as Reference 11. Thus the References and citation numbers were different from each other. Why did the authors need to open reduction in all the fractures treated by using IMN? We wish to thank the authors for their invaluable contribution to the current literature. And we hope that the authors will answer our questions.