Management of humeral shaft fracture: a comparative study between interlocking nail and dynamic compression plating

Abstract

<p class="abstract"><strong>Background:</strong> Fractures of humeral shaft are commonly encountered by orthopaedic surgeons accounting for approximately 3% of all fractures. Treatment of these injuries continues to evolve as advances are made in both operative and non-operative management. Most humeral shaft fractures can be managed non-operatively with anticipated good to excellent results.</p><p class="abstract"><strong>Methods: </strong>29 cases with fracture of shaft of humerus were treated operatively in the Department of Orthopaedics, Katihar Medical College. Out of these, 15 cases (Group-A) underwent internal fixation by humeral interlocking nail and 14 cases (Group-B) underwent internal fixation by dynamic compression plating, with or without bone grafting. Bone grafting was done in 8 cases of Group-A and 5 cases of group-B.</p><p class="abstract"><strong>Results:</strong> All cases, except one from each group returned to their previous occupation. Both these cases developed non-union. They were able to perform daily activities but not able to resume their occupation. Thus the functional result was good in 92.3% of cases and poor in 7.7% of cases of either group. 4 cases in group-B (30.8%) managed by dynamic compression plating developed infections. In this study complications were also observed. Two of them were superficial infections that responded well to antibiotics and dressings and later healed well and united. Two cases developed discharging sinuses and subsequently infected union. Later the plate was removed and sinus tract excised. The sinus tract healed but left unsightly scar marks over the arm. Only one patient (7.7%) of group-A developed deep seated infection and subsequent non-union. 3 cases of group-A (23.1%) developed shortening ranging from 1.5cm to 4cm. All these cases were cases of old non-union with sclerotic bone ends which had to be nibbled and refreshed. Shortening developed in 2 cases (15.4%) of group-B. One non-union was seen in each group. While the screws of one dynamic compression (7.7%) went loose, no implant failure occurred in interlocking nails. One case (7.7%) of group-A developed axillary nerve injury, which might be attributed to the fact that the incision extended 6-7 cm beyond the acromion process. Only one case in group-B developed 10o angulation.</p><strong>Conclusions:</strong> Dynamic compression plating has stood the test of time as an excellent method of stabilizing transverse diaphyseal fractures of humerus. The plate produces a compression at the fracture site promoting osteosynthesis. But the technique is not suitable for segmental fractures, pathological fractures, communited fractures, gross osteoporosis, non-union and fractures much proximal or distal to shaft. Introduction of interlocking nailing has largely solved problems faced by the standard dynamic compression plating technique. An advantage of humerus interlocking is that even when non-union developed daily activities could be performed whereas in cases with loosening of screws it was difficult to do so.