Nailing Of Humeral Shaft Fractures Research Articles

Risk factors of poor mid-term shoulder functional outcomes of osteosynthesis using antegrade intramedullary nailing for humeral shaft fractures: a retrospective study with a minimum 5-year follow-up

BackgroundOsteosynthesis using antegrade intramedullary nailing for humeral shaft fractures yields satisfactory bone union rates; however, it may adversely affect postoperative shoulder function. To date, factors affecting mid- or long-term shoulder functional outcomes following intramedullary nail fixation have not been clarified. In this study, we aimed to identify the risk factors for poor mid-term functional outcomes over 5 years postoperatively following antegrade intramedullary nail osteosynthesis for humeral shaft fractures.MethodsWe retrospectively identified 33 patients who underwent surgery using an antegrade intramedullary nail for acute traumatic humeral shaft fractures and were followed up for at least 5 years postoperatively. We divided the patients into clinical failure and no clinical failure groups using an age- and sex-adjusted Constant score of 55 at the final follow-up as the cutoff value. We compared preoperative, perioperative, and postoperative factors between the two groups.ResultsFive of the 33 patients had poor shoulder functional outcomes (adjusted Constant score < 55) at a mean follow-up of 7.5 years postoperatively. Proximal protrusion of the nail at the time of bone union (P = 0.004) and older age (P = 0.009) were significantly associated with clinical failure in the univariate analyses. Multivariate analysis showed that proximal protrusion of the nail (P = 0.031) was a risk factor for poor outcomes.ConclusionsThe findings of this study provide new information on predictive factors affecting mid-term outcomes following osteosynthesis using antegrade nails. Our results demonstrated that proximal protrusion of the nail was significantly associated with poor mid-term functional shoulder outcomes. Therefore, particularly in older adults, it is essential to place the proximal end of the intramedullary nail below the level of the articular cartilage.

Intramedullary nailing of humeral shaft fractures: percutaneous nailing in the lateral position through the Neviaser approach is a reliable technique

BackgroundDisplaced humeral shaft fractures are frequently treated by osteosynthesis in the active patient. We aimed to evaluate the results of intra-medullary nailing (IMN) in the lateral position with the Neviaser approach and to compare them with those from IMN nailing in the standard position and conventional approach. MethodsIn the retrospectively evaluated, single-center study, we compared 20 cases of long IMN for fractures of the proximal or middle third of the humerus shaft (Multilock; Synthes Laboratory) in the lateral position with the percutaneous Neviaser approach with 52 cases of IMN in the standard position. The mean age of patients was 62+/-21 years. Clinical outcomes were analyzed: Constant score, subjective shoulder evaluation (SSV) score and range of motion (ROM). Radiographically, entry point at the proximal part of the humerus, the healing rate and the possible association between the critical shoulder angle (CSA) and the correct positioning of the nail were assessed. ResultsWith a mean follow-up of 26+/-2 months, the healing rate was 89% (64/72) in the overall series, (8 patients in non-union), with no difference between the 2 groups. The overall mean active anterior elevation (AAE) was 125+/-22 degrees, mean external rotation (ER1) was 35+/-17 degrees, and mean internal rotation (IR) was at L3. The mean Constant score was 58+/-23 and SSV score 73+/-12%. ROMs were better in the lateral than standard position group (AAE 133+/-17 vs 122+/-23, p=0.03; ER1 47+/-13 vs 30+/-16, p<0.001; IR T12 vs L5, p=0.02). The nail was less often protruding in the lateral than standard position group (1/20 [5%] vs 20/52 [38.5%], p=0.002). The nail was better positioned from the anteroposterior view (nail centered: 16/20 [75%] vs 26/52 [50%], p=0.047) and lateral view (nail centered: 18/20 [90%] vs 34/52 [65.4%], p=0.02) in the lateral than standard position group. We found no association between nail position, type of approach and CSA. ConclusionsIn the short-term follow-up, osteosynthesis of humeral shaft fractures by using long IMN in the lateral position with the Neviaser approach is a reliable technique. The positioning of the nail, in particular its entry point, and the clinical results were better with the lateral position and Neviaser approach than with the standard position and conventional approach. Further studies with a larger number of patients, assessment of the learning curve, and analysis of the impact of this technique on comorbidities (unchanged cerebral perfusion) are needed to fully validate this technique.

Shoulder problems after percutaneous antegrade intramedullary nailing in humeral diaphyseal fractures using contemporary straight third-generation nail.

Antegrade intramedullary nailing in humeral shaft fracture has been abandoned by certain orthopedic surgeons because of rotator cuff injury caused by first- and second-generation intramedullary nails (IMNs). However, only a few studies have specifically addressed the results of antegrade nailing for the treatment of humeral shaft fractures with a straight third-generation IMN; thus, complications need to be re-evaluated. We hypothesized that fixation of displaced humeral shaft fractures with a straight third-generation antegrade IMN with the percutaneous technique avoid shoulder problems (stiffness and pain) incurred by first- and second-generation IMNs. This was a retrospective, single-center, nonrandomized study of 110 patients with a displaced humeral shaft fracture between 2012 and 2019 treated surgically with a long third-generation straight IMN. Mean follow-up was 35.6 months (range, 15-44 months). There were 73 women and 37 men with a mean age of 64.7±19 years. All fractures were closed (37.3% 12A1, 13.6% 12B2, and 13.6% 12B3 AO/OTA classification). Mean Constant score was 82±19, Mayo Elbow Performance Score 96±11 and the mean EQ-5D visual analog scale score was 69.7±21.5. Mean forward elevation 150°±40°, abduction 148°±45°, and external rotation 38°±15°. Symptoms associated with rotator cuff disease were present in 6.4%. Evidence of radiographic fracture healing was detected in all but 1 case. One postoperative nerve injury and 1 adhesive capsulitis were present. Overall, 6.3% underwent second surgeries (4.5% were minor surgeries like hardware removal). Percutaneous antegrade intramedullary nailing of humeral shaft fractures with a straight third-generation nail considerably reduced complications related to shoulder problems and achieved good functional results.

Treatment of Iatrogenic Nerve Injury After Humeral Shaft Fracture Fixation: A Case Report

Background. Iatrogenic neuropathies of the radial nerve following intramedullary nailing of the humerus are observed in 2.9% of patients. In 30% of cases, iatrogenic nerve injury is associated with distal nail locking. Questions about the timing and volume of diagnostic measures to determine the nature of nerve damage, methods of conservative and surgical treatment, and their effectiveness remain relevant.&#x0D; Aim of the study to illustrate the causes, prevention methods, diagnosis, and treatment of iatrogenic radial nerve injuries in humeral shaft fractures through a clinical example.&#x0D; Case presentation. A 30-year-old female patient was admitted with a nonunion fracture of the left humerus and iatrogenic radial nerve injury three months after the fracture was fixed with a locking nail. A revision operation was performed: removal of the nail from the left humerus; re-fixation of the left humerus with a plate; revision, neurolysis, and plastic repair of the left radial nerve using autografts from the right sural nerve. Postoperative courses of medication therapy, physiotherapy, and therapeutic exercises were conducted. At 26 months after the surgery, complete range of motion and restoration of strength in active extension of the left wrist and three phalanges, abduction of the first finger, partial extension of the first finger, and restoration of sensitivity on the outer surface of the left forearm and the back of the hand were observed.&#x0D; Conclusion. Iatrogenic radial nerve injury primarily occurs as a result of incorrect technique when introducing locking screws during intramedullary nailing of humeral shaft fractures. Delayed examination and surgical treatment of patients with injured radial nerve lead to a lack of full functional recovery, potential muscle atrophy, and impairment of their motor function. Surgical treatment aimed at restoring the radial nerve at an early stage after injury, combined with a full range of postoperative rehabilitation for a year, is the only correct treatment approach.

An Observational Study on the Functional Outcomes of Intramedullary Nailing Versus Dynamic Compression Plating for Humeral Shaft Fractures

Objectives: The purpose of this research is to evaluate and contrast the functional results of Dynamic Compression Plating and Interlock Nailing for Humeral Shaft Fractures. Material and Methods: The design of this study was a prospective observational study. This study was conducted in DHQ Teaching Hospital Gujranwala and the duration of this study was from October 2020 to December 2022. We evaluated a total of 60 cases after receiving ethics committee permission from our institute. In DHQ Teaching Hospital Gujranwala, a study on instances of humeral shaft fractures needing surgical intervention was conducted. Results: In the plating group, 76.7% of the cases had outstanding results, compared to 56.7% in the nailing group. Moreover, the nailing group had a worse overall result (13.4% vs. 10%). Conclusion: Locking plating and intramedullary nailing had statistically similar results for individuals undergoing surgical intervention for humeral shaft fractures. In terms of union and function, both provide excellent and favourable results, but the dynamic compression plating group had a higher percentage of positive results and a propensity for union. Keywords: Humeral Shaft Fracture, Intramedullary Nailing, Dynamic Compression Plating

Distal locking technique affects the rate of iatrogenic radial nerve palsy in intramedullary nailing of humeral shaft fractures

BackgroundIntramedullary humeral nailing is a common and reliable procedure for the treatment of humeral shaft fractures. Radial nerve palsy is a common complication encountered in the treatment of this pathology. The radial nerve runs from posterior to anterior at the lateral aspect of the distal humerus. Hence, there is reason to believe that due to the anatomic vicinity of the radial nerve in this area, lateral–medial distal locking in intramedullary nailing of the humerus may be associated with a greater risk for iatrogenic radial nerve injury compared to anterior–posterior locking.Questions/purposeTo assess whether the choice of distal locking (lateral–medial versus anterior–posterior distal locking) in intramedullary humeral nailing of humeral shaft fractures affects the risk for iatrogenic radial nerve injury.Patients and methodsOverall, 203 patients (116 females, mean age 64.3 ± 18.6 years), who underwent intramedullary nailing of the humerus between 2000 and 2020 at a single level-one trauma center, met the inclusion criteria and were analyzed in this retrospective case–control study. Patients were subdivided into two groups according to the distal locking technique.ResultsAnterior–posterior locking was performed in 176 patients versus lateral–medial locking in 27 patients. We observed four patients with iatrogenic radial nerve palsy in both groups. Risk for iatrogenic radial nerve palsy was almost 7.5 times higher for lateral–medial locking (OR 7.48, p = 0.006). There was no statistically significant difference regarding intraoperative complications, union rates or revision surgeries between both groups.ConclusionsLateral–medial distal locking in intramedullary nailing of the humerus may be associated with a greater risk for iatrogenic radial nerve palsy than anterior–posterior locking. Hence, we advocate for anterior–posterior locking.Level of evidenceLevel III retrospective comparative study.

Intramedullary nailing for humeral shaft fractures: Is distal locking necessary?

IntroductionIntramedullary (IM) nailing of humeral shaft fractures is a reliable means to achieve bone union while allowing early motion. The hypothesis was that distal locking is unnecessary due to good primary stability of the impacted nail in the distal, truncated cone portion of the medullary canal. The primary objective of this study was to confirm the success of the procedure without distal locking by identifying failure criteria. The secondary objectives were to compare the outcomes of IM nailing with and without distal locking. Material and methodsThis was a retrospective, single-center, non-randomized study of 128 patients with a humeral shaft fracture between 2012 and 2020 treated surgically with a long IM nail. Proximal locking was done in every case, then the rotational stability of the nail was tested. Stable nails were not locked distally (group A), while unstable nails were locked distally through an anterior approach (group B). All patients were reviewed with at least 12 months’ follow-up. ResultsDistal locking was performed in 30 patients (mean age 63, 17–91) while the fracture in 98 patients (mean age 65, 20–93) did not require distal locking. The average time to union was 4 months (2–6). The average operative time in group B was 87min (35–185) with 90s fluoroscopy time (33–158) versus 52min (20–127) with 44 s fluoroscopy time (12–143) in group A (p<0.05). Four patients in group B suffered postoperative radial nerve palsy and two others had another fracture at the level of the distal locking screws. The union rate did not differ between groups (Group A 94.6%, group B 86.2%, p=0.217) nor did the functional recovery – SSV of 79.5 (10–100) in group A versus 76 (40–100) in group B (p=0.271) – or the range of motion (p>0.05). There were no instances of rotational malunion. DiscussionExcept for certain distal third fractures, distal locking is not necessary to achieve bone union when the nail is impacted into the medullary canal. This reduces the operative time, fluoroscopy time and risk of neurological damage. Level of evidenceIV.

To Study Functional Outcome of Humeral Shaft Fractures Treated by Intramedullary Nailing Versus Dynamic Compression Plating at a Tertiary Health Care Centre

Background: The proportion of humeral shaft fractures being treated conservatively reportedly varies from 33% to 95%. Nonsurgical treatment results in higher incidence of union and fewer complications than open reduction and internal fixation. Aims and Objectives: To study and compare the functional outcome of Dynamic Compression Plating and Interlock Nailing for humeral shaft fractures. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of sixty cases over a span of 36 months – October 2018 to December 2020. Study was carried out on cases of humeral shaft fractures requiring operational intervention in department of orthopaedics of tertiary care centre in Maharashtra. Results: A total of 76.7% cases in plating group had excellent outcome as compared to 56.7% in nailing group. Also poor to fair outcome was noted more in nailing group (13.4% vs 10%). Conclusion: Statistically comparable results have been observed for patients undergoing surgical intervention for humeral shaft fractures among locking plating and intramedullary nailing. Both provide excellent and favourable results in terms of union and function, however a higher rate of excellent results and tendency for union was seen with dynamic compression plating group.

Comparison of Expandable and Locked Intramedullary Nailing for Humeral Shaft Fractures.

IntroductionIn this study, we clinically and radiologically investigated whether the application of expandable nails for surgical treatment of humeral shaft fractures has an advantage over locked intramedullary nails.MethodsPatients treated with intramedullary fixation due to humeral shaft fractures in our clinic were investigated retrospectively. Patients with fractures of type 12A and 12B according to the AO classification in the middle 1/3 shaft region of the humerus were divided into two groups as those receiving fixation with expandable nails and with locked intramedullary nails. The union rate, union time, Q-DASH scores, duration of surgery, and complication rates were statistically compared between the two groups.ResultsThe study included 38 patients with clinical follow-up from among 47 patients; 20 patients received fixation with locked intramedullary nails and 18 with expandable nails. The mean age of the patients was 56.92 (19-91) years and 53% (n=20) were men while 47% (n=18) were women. During statistical evaluation, a statistically significant difference was found between the groups for union (100% and 72.2%) and complication rates (6% and 13%). More union and lower complication rates were found in patients treated with locked intramedullary nails. In comparing the mean of surgical times (71.1 and 30.2 min), expandable nails had a shorter surgical time. However, there was no statistically significant difference between the union time and Q-DASH scores between the two groups.ConclusionLocked intramedullary nails are a better fixation method than expandable nails due to the low complication rate and high rate of union. However, due to shorter surgery time, expandable nailing is an alternative method in limited cases.

Secondary radial neuropathy after closed intramedullary nailing of humeral shaft fractures. Results over a 10-year period

Retrospective study to examine secondary radial nerve palsy after humeral shaft fixation with closed locked intramedullary nailing. Patients were identified from the hospitals' registration systems for humeral shaft fractures, nerve lesions, plating, nailing and external fixation during a 10-year period from January 2007 to December 2016. All radial nerve lesions were registered and followed-up in patient files. 89 patients with locked intramedullary nailing were available for an outpatient follow-up. Mean age was 67 years at the time of injury. 72 fractures were non-pathological. Of these, 31 were nonunions. 28, 61 and zero were identified in the proximal, middle and distal thirds of the humeral shaft respectively. 76 procedures were closed and 13 were with open reduction. Six radial nerves had nerve exploration. Eight patients developed immediate postoperative radial nerve palsies. Of these, six developed after closed surgery, two after nerve exploration. Of seven available patients with a radial nerve palsy, six of these remitted. Two patients were later surgically explored. One patient out of 89 sustained a verifiable permanent radial nerve paralysis. In this study, the risk of a radial nerve palsy was 7.9 % with closed locked intramedullary nailing. This study suggests that exploration of the radial nerve is not necessary routinely in order to prevent radial nerve lesions when performing closed intramedullary nailing for humeral shaft fractures in adults with a preoperative normal radial nerve function. Level IV.

Radial nerve recovery following closed nailing of humeral shaft fractures without radial nerve exploration: A retrospective study.

BACKGROUNDRadial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures. An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness. We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIMTo assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODSWe retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1, 2016, and March 31, 2020. Subsequently, we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTSThe study included 70 patients who underwent surgical treatment for closed- or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration. The patients suffered from primary (n = 5) and secondary (n = 5) radial nerve palsy. A 100% radial nerve recovery rate was achieved. The mean recovery time was 4.3 mo.CONCLUSIONThe study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment. Surgeons need not be concerned about the occurrence of permanent nerve palsies.

Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies.

This meta-analysis compares open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures with regard to union, complications, general quality of life and shoulder/elbow function. PubMed/Medline/Embase/CENTRAL/CINAHL was searched for observational studies and randomised clinical trials (RCT). Effect estimates were pooled across studies using random effects models. Results were presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95% CI). Subgroup analysis was performed stratified for study design (RCTs and observational studies). Eighteen observational studies (4906 patients) and ten RCT's (525 patients) were included. The pooled effect estimates of observational studies were similar to those obtained from RCT's. More patients treated with nailing required re-intervention (RD 2%; OR 2.0, 95% CI 1.0-3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD 2%; OR 0.4, 95% CI 0.3-0.6). Notably, all but one of the radial nerve palsies resolved spontaneously in each groups. Nailing leads to a faster time to union (mean difference - 1.9weeks, 95% CI - 2.9 to - 0.9), lower infection rate (RD 2%; OR 0.5, 95% CI 0.3-0.7) and shorter operation duration (mean difference - 26min, 95% CI - 37 to - 14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores. Nailing carries a lower risk of infection, postoperative radial nerve palsy, has a shorter operation duration and possibly a shorter time to union. Shoulder impingement requiring re-intervention, however, is an inherent disadvantage of nail fixation. Notably, absolute differences are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities.

ORIF versus nailing for humeral shaft fractures: A meta-analysis and systematic review of randomised clinical trials and observational studies

Abstract Objective This meta-analysis aims to compare open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures in terms of healing, complications, general quality of life and shoulder/elbow function. Methods PubMed/Medline/Embase/CENTRAL/CINAHL was searched for both randomised clinical trials (RCT) and observational studies comparing ORIF with nailing for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies). Results A total of ten RCT's (525 patients) and eighteen observational studies (4906 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. More patients treated with nailing required re-intervention (RD: 2%; OR 2.0, 95%CI 1.0 – 3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD: 2%; OR 0.4, 95% CI 0.3 – 0.6). Notably, all but one of the radial nerve palsies resolved sponta-neously in each groups. Nailing leads to a faster time to union (mean difference: -1.9 weeks, 95%CI -2.9 – -0.9), lower infection rate (RD: 2%; OR: 0.5, 95%CI 0.3 – 0.7) and shorter operation duration (mean difference: -26 minutes, 95%CI -37 – -14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores. Conclusion Nailing carries a lower risk of infection, postoperative radial nerve palsy, shorter operation duration, and time to union. Absolute differences, however, are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities and both techniques have their inherent pros and cons.

MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies

MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies

Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study.

To compare the radiological and clinical outcomes of interlocking nail (ILN) and locking plate fixation (LCP) for humeral shaft fractures. A total of 63 patients with displaced humeral shaft fractures between October 2014 and January 2017 were evaluated prospectively. They were divided randomly into two as LCP fixation (group 1) and interlocking nail (ILN) (group 2). Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles (UCLA) shoulder scores, and Short Form-36 (SF-36) questionnaires, and pain was assessed with visual analogue scale (VAS). After fracture callus was radiologically observed, DASH, ASES, and UCLA scores as well as SF-36 questionnaires and VAS results were noted to have no significant difference between the two groups (p = 0.109, p = 0.082, p = 0.146, p = 0.322, and p = 0.175, respectively). At the last follow-up (post-operative 24months), the UCLA score was significantly better in group 1 (p = 0.034), whereas VAS result was significantly worse in group 2 (p = 0.017). DASH, ASES scores, and SF-36 questionnaires had no difference (p = 0.193, p = 0.088, p = 0.289). Other parameters revealed no significant differences. Fracture consolidation was observed at a mean of fourmonths in both groups (3 to 7months in group 1 and 3 to 8months in group 2) (p = 0.189). Four patients in group 1 and five patients in group 2 underwent surgery for nonunion (p = 0.725). Post-operative radial nerve palsy was seen in one patient in group 2. Two patients in group 1 with superficial infection were treated with antibiotics, and they recovered. Regarding our results, the LCP group had significantly better shoulder function than the ILN group, whereas the ILN group had significantly less pain, with similar complication rates. Therefore, both procedures are favourable surgical options for patients with humeral shaft fractures.

Humeral interlocking intramedullary nailing without image intensifier in a developing country

Background: Interlocking intramedullary nailing under image intensifier has been a standard approach to surgical treatment of humeral fractures. Aim: We present the outcome of humeral interlocking nailing without image intensifier in a developing country. Materials and Methods: This is a prospective study of consecutive patients with humeral shaft fractures who were treated with Surgical Implant Generation Network interlocking nailing for humeral shaft fractures using an external jig system. They were followed up for at least 6 months if there was no evidence of fracture healing and restoration of functional activities. Data collected were processed with the Statistical Package for the Social Sciences and summarised in percentages and means. Results: Forty-five patients with 46 humeral shaft fractures were studied, with a mean age and standard deviation of 46 ± 14.6 years and male-female ratio of 1.8:1. At 3 months, 44 (95.7%) of the patients have had radiographic evidence of fracture healing. Over the same period, 35 (76.1%) of them had achieved shoulder abduction >90°, 37 (80.5%) had achieved painless shoulder flexion-abduction-external rotation movement and 42 (91.3%) had achieved full activities of daily living. Conclusion: In a resource-constrained population where image intensifier is difficult to come by, humeral interlocking intramedullary nailing could still be performed using external jig system with a satisfactory outcome.

A biomechanical analysis of intramedullary nailing for humeral shaft fractures using 3D-finite element method

Background: Intramedullary nailing by antegrade and retrograde technique was introduced in humeral shaft fractures after interlocking nailing of femoral and tibial fractures achieved excellent results. The aim of this study was to evaluate biomechanical properties of antegrade and retrograde nailing in diaphyseal fractures according to levels of the humerus. Methods: To estimate and compare biomechanical stability of antegrade and retrograde nailing, 3D geometrical and finite element method (FEM) models of the humeral fractures and intramedullary nails were formed using Solidworks software, based on CT scans of the humerus and analyzed with ANSYS 15.0 program. Biomechanical analysis was performed under three types of loads: anterior-posterior (AP) bending, torsion and axial compression. Results: The bending properties of antegrade nailing were higher than those of retrograde nailing in any site of the humeral shaft fractures. During the testing under torsion, antegrade nailing showed that the displacements of fracture sites were lower compared to those retrograde nailing in the proximal and distal diaphyseal fractures. Under axial compression, antegrade intramedullary nailing demonstrated that the stiffness and displacement were found to be lower than those by retrograde nailing in the distal shaft of the humerus and there were no significant differences in stiffness and displacement between antegrade and retrograde nailing in the proximal diaphyseal and midshaft fractures. Conclusions: For the proximal and distal shaft fractures of the humerus, the stability of antegrade nailing was higher than the stability of retrograde nailing. In the midshaft fractures of the humerus, there was no biomechanical difference between antegrade and retrograde technique.

Antegrade versus retrograde nailing in humeral shaft fractures: A prospective study

Antegrade versus retrograde nailing in humeral shaft fractures: A prospective study

Comparative study of radiological and clinical outcomes by using single and double interlocking distal screws for humerusshaft fractures

Background: The aim of this study was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on ahumerus intramedullary nail for the internal fixation of humeral shaft fractures. Methods: From April 2010 to April 2015, 30 patients were enrolled with humeral shaft fractures who were operated on using intra medullary humerus nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the humerus nail: in group 1, a single interlocking distal screw was used in 16 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. Shoulder function of patients wereassessed by modified American Shoulder and Elbow Surgeons (ASES) score. Results: We found that 15 (93.7%) fractures achieved union in group 1, and 13 (92.8%) of fractures, in group 2. There was no meaningful difference in the time to bone union and the recovery of displaced fracture fragments between the two groups. At the final follow-up, we found that the scores for shoulder joint modified ASES was 76.2 for group 1 and 79. 1 for group 2. Conclusions: This study shows that if locked appropriately, even a single screw on a humerusnail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.

Electromagnetic distal targeting system does not reduce the overall operative time of the intramedullary nailing for humeral shaft fractures

IntroductionWe aimed to evaluate the efficacy of the use of the electromagnetic distal targeting system in treating humeral shaft fracture. MethodsPatients were divided in: Group 1) patients that received a distal locking screw placement following the free-hand technique; Group 2) patients in which the distal locking screw was performed using the SURESHOT device. ResultsNo differences were noted comparing Group 1 (freehand) [71,9 range 40–135 min] to Group 2 (SURESHOT)[70, range 25–125 min]. ConclusionThe use of the EM distal targeting system doesn't reduce the overall operative time of the humeral shaft fracture fixation using IMN.