Treatment of fractures of the proximal end and humeral shaft by locked intramedullary nailing in adults: Case series and literature review

Omar Fadili Omar Fadili,Mohamed Laffani Mohamed Laffani,Abdellah Chrak Abdellah Chrak,Mustapha Fadili Mustapha Fadili,Bienvenu Jean Celien Okouango Bienvenu Jean Celien Okouango,Souhail Echoual Souhail Echoual

doi:10.30574/wjarr.2021.10.3.0251

Abstract

Introduction: Intramedullary nailing is a good indication for stabilizing displaced fractures of the proximal end and shaft of the humerus in adults. Methods: This was a prospective series of 24 patient, over a period of 9 months. The aim of this study is to report the epidemiological and clinical aspects of patients treated with a locked humeral nail and to show the medium-term interest, of this therapeutic method, thus discussing the complications. Results: All patients had received intramedullary nailing of the humerus. The average age was 77.08 years. The female sex was more represented with 66.66% and the right side was frequently fractured with 83.33%. We distinguished 50% of cases involving the proximal end of the humerus, 45.87% of cases of the humeral shaft and one case of concomitant fracture of the proximal end and that of the humeral shaft. The postoperative infection rate is zero in our series and we reported 1 case of distal locking screw breakage, 1 case of iterative fracture on short Telegraph nail, 1 case of proximal screw retraction on long Telegraph nail and 1 case of perforation of the humeral head with a proximal locking screw. Conclusion: humeral intramedullary nailing is a good alternative in fixing proximal end and humeral shaft fractures without considerable complications or damages for the rotator cuff muscles.

Highlights

Intramedullary nailing is a good indication for stabilizing displaced fractures of the proximal end and te shaft of the humerus in adults
Of cases involving the proximal end of the humerus, 45.87% of cases of the humeral shaft and one case of concomitant tr fracture of the proximal end and that of the humeral shaft
The postoperative infection rate is zero in our series and we reported 1 case of distal locking screw breakage, 1 case of iterative fracture on short Telegraph nail, 1 case of proximal screw retraction on long Telegraph nail and 1 case of perforation of the humeral head with a proximal locking screw

Summary

Introduction

Intramedullary nailing is a good indication for stabilizing displaced fractures of the proximal end and te shaft of the humerus in adults. In France, it was Seidel in 1986 who described for the first time a nailing system for shaft fractures of the humerus with distal locking by intramedullary expansion [3], thanks to a nailing material allowing locking. The indications for nail internal fixation at the level of the humerus mainly concern displaced fractures of the proximal end [5,6] and of the diaphysis, which makes it possible to obtain better stability and control of stresses, rotational [5] [7]. We conducted a prospective study on a series of 24 patients with a humerus fracture treated with closed method locked intramedullary nailing (short and long nails) over a period of 9 months. The aim of this study is Corresponding author: Omar Fadili Traumatology-Orthopedic and Reconstructive Surgery Department, Ibn Rochd University Hospital, Casablanca, Morocco

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