Abstract
Purpose This study aims to compare the functional outcomes of nonunion humeral diaphyseal fractures following conservative treatment when managed surgically with either a plate or intramedullary (IM) nail fixation. Methods This was a retrospective study of 56 patients with nonunion humeral fractures following conservative treatment who underwent plate or IM nail fixation between 2007 and 2014. Comparison was made for short term profile (intraoperative blood loss, duration of surgery, and length of hospitalization) and long term clinical outcome with functional score (Constant-Murley score (CMS)) and Disabilities of the Arm, Shoulder and Hand (DASH) score). The union and complication rate were also compared. Results There were 36 and 20 patients included in plate and IM nail fixation group with the average of 36.14 ± 7.54-month follow-up time. The intraoperative blood loss, duration of surgery, and length of hospitalization were superior in IM nail group compared to plate group (p < 0.001, p < 0.001, and p < 0.001, respectively). The mean CMS and DASH score were superior in the plate group compared to the IM nail group (82.40 ± 16.84 versus 77.58 ± 12.96; 17.46 ± 11.05 versus 20.86 ± 11.63, respectively; with p = 0.246, p = 0.299, respectively). Plate fixation group showed higher union rate and complication rate compared to IM nail group (100% versus 90%, 13.8% versus 10%, respectively). Conclusions IM nail and plate fixation demonstrated comparable clinical outcome. IM nail fixation showed superior short term result with lower complication rate which benefits the elderly group patients with significant comorbidities.
Highlights
A nonunion of the humeral shaft is not unusual in clinical practice and is a complication of both conservative and operative treatment [1, 2]
Several surgical methods are used in the treatment of humeral shaft nonunion, including open plating, IM nailing, and external fixation, very few studies have directly compared the outcomes associated with these different approaches especially for nonunion following conservative treatment
The additional findings of the current study are (1) the superiority of short term profile for intramedullary nail (IM nail) fixation group compared to plate fixation group and (2) the average complication rate for IM nail group lower than those observed in plate fixation group
Summary
A nonunion of the humeral shaft is not unusual in clinical practice and is a complication of both conservative and operative treatment [1, 2]. Nonunion of the humeral shaft will result in debilitating pain with significant functional loss resulting in long absence of work and life quality impairment. Such condition require operative treatment to achieve adequate fixation often complicated by infection, prior surgical history, and significant bone loss [4,5,6]. IM nail has been known to have several benefits from its relative stability characteristic such as minimal soft tissue dissection and ability to provide adequate reduction. It has several drawbacks such as less
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