Tips and tricks in interlocking nailing in distal one third humerus shaft and segmental fractures of humerus

Abstract

Background: The conventional methods like conservative treatments are well accepted for managing shaft fractures of humerus. But this needs continuous frequent vigilance on the clinical and radiological follow up to see any displacements and may need to change the line of treatment requiring surgical intervention. Closed Interlocking nailing of humerus mid shaft is routinely done as frequently as open plating because of its encouraging results. Fractures of distal one third humerus shafts are challenging for nailing especially if there is comminution and segmental fracture with short distal segment. Distal humerus fractures can be stabilised with intramedullary interlocking nails, provided adequate length is available in distal segment. The aim of this study is to explain difficulties faced in closed interlocking nailing of distal one third and below distal one third humerus shaft and solutions to overcome them and remove the hesitancy of performing nailing without any complications in such circumstances in a closed technique with minimal surgical trauma. Materials and Methods: A prospective study of 27 patients with fracture of Humerus shaft at and below one third level fractures was done. They were treated by closed interlocking nailing in period of five years from 2014 -2019. These patients were followed up till fracture union & evaluated further postoperatively for finding its benefits over open plating. Results: In our study, the age varied from 25 to 68 years. The mean age of patients was 45 years. 18 were males (65%) and 9 were females (35%). The results were based on type of fracture and healing period, infection, stiffness of elbow, restriction of movements. The results were encouragingly excellent in clinical radiological and functional outcome. Conclusions: From our present study we conclude that closed nailing of distal humerus fracture is a reliable minimal invasive alternative procedures than extensive open reduction and plating. It is especially benef