Abstract
We read with interest the article “Pathological fracture of the distal humerus treated with Nancy nails” Dalal and Gibson. 1 Dalal S. Gibson R.J. Pathological fracture of the distal humerus treated with Nancy nails. Injury, Int. J. Care Injured. 2004; 35: 327-328 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar This case study advocated Nancy Nails for the prophylactic fixation of the distal humerus to protect against an impending fracture through a metastatic lesion. We feel this has three theoretical drawbacks. Firstly, it is of concern that in a non-weight bearing long bone insertion of nails can lead to distraction of the fracture. A locking nail system allows fracture compression, a technique not available with the Nancy nail. Furthermore, the authors favoured technique would not confer the rotational stability needed in the upper limb. There was no formal testing or grading of elbow or shoulder function in the case study. Recent studies have advocated the use of inflatable intramedullary nails in cases of pathological fracture. 2 Franck W.M. Olivieri M. Janhasch O. Honnig F.F. An expandable nailing system for the management of a pathological fracture of the humerus. Anal. Orthop. Trauma Surg. 2002; 122: 400-405 PubMed Google Scholar , 3 Smith M.G. Canty S.J. Khan S.A. Fixion-an inflatable or deflatable nail?. Injury, Int. J. Care Injured. 2004; 35: 329-331 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar These implants achieve rotational stability by ensuring endosteal fricton along the length of the inplant via inflation. Although in one of the papers the nail inadvertently deflated. 3 Smith M.G. Canty S.J. Khan S.A. Fixion-an inflatable or deflatable nail?. Injury, Int. J. Care Injured. 2004; 35: 329-331 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Is it not also theoretically possible that seeding of tumour cells may occur if the Nancy nail passes through the fragile cortex in to the surrounding soft tissue.
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