Nailing Of Humeral Shaft Fractures Research Articles

USERʼS GUIDE TO THE ORTHOPAEDIC LITERATURE

• Investigators who perform a systematic review address a focused clinical question, conduct a thorough search of the literature, apply inclusion and exclusion criteria to each potentially eligible study, critically appraise the relevant studies, conduct sensitivity analyses, and synthesize the information to draw conclusions relevant to patient care or additional study. • A meta-analysis is a quantitative (or statistical) pooling of results across eligible studies with the aim of increasing the precision of the final estimates by increasing the sample size. • The current increase in the number of small randomized trials in orthopaedic surgery provides a strong argument in favor of meta-analysis; however, the quality of the primary studies included ultimately reflects the quality of the pooled data from a meta-analysis. The conduct and publication of systematic reviews of the orthopaedic literature, which often include statistical pooling or meta-analysis, are becoming more common. This article is the third in a series of guides evaluating the validity of the surgical literature and its application to clinical practice. It provides a set of criteria for optimally interpreting systematic literature reviews and applying their results to the care of surgical patients. Authors of traditional literature reviews provide an overview of a disease or condition or one or more aspects of its etiology, diagnosis, prognosis, or management, or they summarize an area of scientific inquiry. Typically, these authors make little or no attempt to be systematic in formulating the questions that they are addressing, in searching for relevant evidence, or in summarizing the evidence that they consider. Medical students and clinicians seeking background information nevertheless often find these reviews very useful for obtaining a comprehensive overview of a clinical condition or area of inquiry. When traditional expert reviewers make recommendations, they often disagree with one another, and their advice frequently lags behind, or …

Antegrade locked intramedullary nailing in humeral shaft fractures

Thirty-three humeral nailings were carried out using the Russell–Taylor nail. Twenty-two acute fractures and one non-union united, gave an overall union rate of 70%. Eighteen patients (56%) experienced pain in the shoulder or at the fracture site. Thirteen patients (41%) had poor shoulder function. Only 17 (51%) of the patients were satisfied with the outcome. Fourteen patients (42%) needed further surgery. We conclude that antegrade intamedullary nailing of humeral shaft fractures leads to a substantial risk of non-union and impairment of shoulder function. There was no significant correlation between fracture comminution and fracture healing in our study.

Nonunion after intramedullary nailing of humeral shaft fractures.

To assess results of exchange nailing in nonunion after intramedullary (IM) nailing of humeral shaft fractures. This was a retrospective study; 24 patients with nonunion after IM nailing of humeral shaft fractures were reviewed. In 13 cases, nonunion was treated using exchange nailing, and 11 patients were treated nonoperatively. Union was assessed from radiographs. Shoulder joint symptoms and function were assessed after a mean 4.7 years' follow-up using Constant-Murley scoring and self-administered questionnaires devised by L'Insalata et al. Single or repeated exchange nailing resulted in union in 6 of 13 patients. Shoulder joint function was satisfactory (mean Constant-Murley score of 72) for those patients whose fracture eventually united and poor (mean Constant-Murley score of 39) for those left with nonunion. Exchange nailing results in a poor union rate in nonunion after IM nailing of humeral shaft fractures. Permanent nonunion of the humeral shaft leaves the patient with severe disability.

Rotational alignment of humerus after closed locked nailing.

Rotational malalignment that may happen during closed nailing of humeral fractures is, to date, an unexplored area of investigation. The purpose of this study was to examine the effect of arm position during surgery on humeral rotational alignment and the effect of this alignment on shoulder motion and function. Thirty patients with eventual fracture healing after closed humeral locked nailing were retrospectively studied: 15 had retrograde nailing; 15, antegrade. Retrograde nailing was performed with the patient in a decubitus position and with the upper arm anteriorly flexed and the forearm perpendicular to the operating table. Antegrade nailing was performed with the patient in a semisitting position and with the upper arm in the so-called resting position. The humeral retroversion angle as measured by computed tomographic scan, range of shoulder rotation, and Neer score of the shoulder for the fractured and the intact humeri were determined, and the discrepancy (i.e., value for the intact subtracted from that for the fractured) between the two was noted. To test the effect on alignment of positioning during retrograde nailing, we similarly determined retroversion angles for another 15 patients treated in a supine resting position. Between antegrade nailing and retrograde nailing in decubitus position, there was a significant difference in the mean discrepancies for the retroversion angles and the range of external rotation of the shoulder in the neutral and abduction positions, but no significant difference for internal rotation of the shoulder and Neer score. Between antegrade nailing and retrograde nailing in supine resting position, there was no significant difference in the mean discrepancy for the retroversion angle. Positioning of the arm may significantly affect humeral rotational alignment and range of motion during closed nailing. Until a reliable method for intraoperative measurement of humeral rotation is devised, we recommend that closed nailing of humeral shaft fractures be performed with the patient's upper arm in the resting position shown in this study.

Retrograde nailing of humeral shaft fractures: a biomechanical study of its effects on the strength of the distal humerus.

The purpose of this study was to evaluate the loss of strength in the distal humerus that resulted from the creation of two different entry portals used for retrograde humeral nailing. Nine pairs, treated as blocks of size two, of fresh frozen humeri from individuals free of musculoskeletal disease were randomly divided into three groups in a balanced incomplete block experimental design. The specimens were tested intact (control) or with an entry portal drilled in either the distal metaphyseal triangle or the proximal slope of the olecranon fossa. Two of these three conditions were applied to each pair of the bones. Therefore, three pairs of bones accommodated testing of all possible combinations of the two treatments. All specimens were tested in torsion at a rate of 30 degrees per second until failure or fracture. The creation of an entry portal reduced the ultimate torque to 63 percent of that of the intact specimens (p = 0.044) and the energy absorbed to failure to 27 percent of that of the intact specimens (p = 0.039). The metaphyseal entry portal reduced the torque to failure to 71 percent of that of the intact specimens (p = 0.143) and the energy absorbed to failure to 37 percent of that of the intact specimens (p = 0.073), The olecranon fossa entry portal reduced the torque to failure to 55 percent of that of the intact specimens (p = 0.035) and the energy absorbed to failure to 18 percent (p = 0.058) of that of the intact specimens. Surgeons should be aware of the loss of strength in the distal humerus after retrograde humeral nailing. This is especially important when prescribing postoperative mobilization in which the upper extremities will be used for weight-bearing in either transfers or ambulation.

Retrograde locked nailing of humeral shaft fractures using the unreamed humeral nail (UHN)

Objectives Bony consolidation of humeral fractures in anatomical reduction. Rapid rehabilitation. Restoration of normal function.

Complications of Marchetti locked nailing for humeral shaft fractures.

In this retrospective study 50 humeral fractures (36 acute, 6 pathological fractures and 8 non-unions) were treated by retrograde locked bundled Marchetti nailing. No intraoperative complications occurred. Postoperative complications included 7 non-unions (4/36 acute fractures and 3/8 delayed union), and 2 intraarticular penetrations of the secondary nails. However, at the subsequent removal of the implant 5 supracondylar fractures occurred.

Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases.

Antegrade intramedullary nailing with four different implants was used in 126 humeral shaft fractures. There were 74 acute fractures, 17 pathologic fractures, 16 fractures malaligned in a hanging cast or brace, 15 fractures with delayed union and 4 fractures that were nailed after failed open reduction and internal fixation. The nonunion rate was 21/95 after primary operation, and after reoperations 14/95. Distraction of the fracture was a significant cause of nonunion, but not type of fracture, localization, implant, and delay between injury and surgery. Shoulder joint function was significantly impaired in 25/67 patients. The patients regarded the result as good or satisfactory in 41/67 of the cases who were followed mean 3 (0.5-10) years. We conclude that antegrade intramedullary nailing of humeral shaft fractures leads to a substantial risk of non-union and impairment of shoulder function. It can be recommended as primary treatment only when nonoperative treatment is likely to fail.

Retrograde Nailing of Fresh and Pathologic Humeral Shaft Fractures With a New Unreamed Humeral Nail (UHN)

Summary Intramedullary nailing of humeral shaft fractures is still a controversial issue. The comments and experience with antegrade nailing vary from enthusiasm to criticism. Main criticisms concern the damage of the rotator cuff and articular cartilage and possible impingement syndrome. The new unreamed humeral nail (UHN) is being used for antegrade and retrograde insertion. We describe the technique of retrograde nail insertion. The nail is 6.7, 7.5, or 9.5 mm. It has one curvature of 4° at the transition proximal to second fourth. There are three interlocking possibilities at the nail base and nail tip. Interfragmentary compression is achieved through a compression device. The entry portal for nail insertion is situated above the olecranon fossa; the elbow capsule is not opened. The occurrence of a supracondylar fissure or fracture and secondary damage to the radial or axillary nerve are the most feared complications. In a series of 190 retrograde nailings, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%). All radial nerve palsies recovered spontaneously. Sixty-eight patients were followed up until fracture healing. There were five (7.4%) bone healing problems. Four of five could be solved with the use of the unreamed humeral nail in a second operative procedure, whereas the fifth required plate osteosynthesis. Function of the shoulder and elbow joint was excellent in 89.7% and 88.3% of the patients, respectively. The UHN is a valuable addition to the implants, available for operative treatment of fresh or pathologic humeral shaft fractures. Retrograde humeral nailing is a safe and reliable procedure if done properly. Bone healing problems after unreamed humeral nailing must be analyzed individually, but they can be treated with the same implant in combination with cancellous bone grafts, reaming, additional hardware, or intrafragmentary compression.

Retrograde Nailing of Fresh and Pathologic Humeral Shaft Fractures With a New Unreamed Humeral Nail (UHN)

Summary Intramedullary nailing of humeral shaft fractures is still a controversial issue. The comments and experience with antegrade nailing vary from enthusiasm to criticism. Main criticisms concern the damage of the rotator cuff and articular cartilage and possible impingement syndrome. The new unreamed humeral nail (UHN) is being used for antegrade and retrograde insertion. We describe the technique of retrograde nail insertion. The nail is 6.7, 7.5, or 9.5 mm. It has one curvature of 4° at the transition proximal to second fourth. There are three interlocking possibilities at the nail base and nail tip. Interfragmentary compression is achieved through a compression device. The entry portal for nail insertion is situated above the olecranon fossa; the elbow capsule is not opened. The occurrence of a supracondylar fissure or fracture and secondary damage to the radial or axillary nerve are the most feared complications. In a series of 190 retrograde nailings, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%). All radial nerve palsies recovered spontaneously. Sixty-eight patients were followed up until fracture healing. There were five (7.4%) bone healing problems. Four of five could be solved with the use of the unreamed humeral nail in a second operative procedure, whereas the fifth required plate osteosynthesis. Function of the shoulder and elbow joint was excellent in 89.7% and 88.3% of the patients, respectively. The UHN is a valuable addition to the implants, available for operative treatment of fresh or pathologic humeral shaft fractures. Retrograde humeral nailing is a safe and reliable procedure if done properly. Bone healing problems after unreamed humeral nailing must be analyzed individually, but they can be treated with the same implant in combination with cancellous bone grafts, reaming, additional hardware, or intrafragmentary compression.

Interlocking nailing of humeral shaft fractures: experience with the Russel-Taylor nail, 1991 to 1994

Interlocking nailing of humeral shaft fractures: experience with the Russel-Taylor nail, 1991 to 1994

A Comparison of the Using of Plate fixation and Ender nailing in Humeral Shaft Fractures

A Comparison of the Using of Plate fixation and Ender nailing in Humeral Shaft Fractures

Retrograde locked nailing of humeral shaft fractures

The Journal of Bone and Joint Surgery. British volumeVol. 77-B, No. 4 ArticlesFree AccessRetrograde locked nailing of humeral shaft fracturesD McKeeD McKeeSearch for more papers by this authorPublished Online:1 Jul 1995https://doi.org/10.1302/0301-620X.77B4.7615626AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByReview of Existing, Mounted Targeting Devices for Distal Locking of Intramedullary Nails Vol. 77-B, No. 4 Metrics Downloaded 19 times History Published online 1 July 1995 Published in print 1 July 1995 InformationCopyright © 1995, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Retrograde locked nailing of humeral shaft fractures. A review of 39 patients

We treated 39 patients with fractures of the humeral shaft by closed retrograde locked intramedullary nailing, using Russell-Taylor humeral nails. The mean healing time of all fractures was 13.7 weeks. After consolidation, shoulder function was excellent in 92.3% and elbow function excellent in 87.2%. Functional end-results were excellent in 84.6% of patients, moderate in 10.3% and bad in 5.1%. One patient had a postoperative radial nerve palsy, which recovered within three months. There was additional comminution at the fracture site in three patients (7.7%) which did not affect healing, and slight nail migration in two older patients (5.1%). Two patients (5.1%) needed a second procedure because of disturbed fracture healing. One screw breakage was seen in a patient with delayed union. Retrograde locked humeral nailing appears to be a better solution for the stabilisation of fractures of the humeral shaft than anterograde nailing or plate and screw fixation. We found the complication rate to be acceptable and shoulder and elbow function to recover rapidly in most cases.

Closed Locked Intramedullary Nailing for Humeral Shaft Fractures

Closed Locked Intramedullary Nailing for Humeral Shaft Fractures

Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results

We report our experience with a modified implant and a new technique for locked intramedullary nailing of the humerus in 41 patients. Locking was by cross-screws placed from lateral to medial in the proximal humerus, and anteroposteriorly in the distal humerus. Early in the series, 11 nails were inserted at the shoulder, but we found that rehabilitation was faster after retrograde nailing through the olecranon fossa, which was used for the other 30. We used a closed technique for 29 of the nailings. Of the 41 patients treated, 21 had acute fractures, five had nonunion, and 15 had pathological fractures. Secure fixation was obtained for comminuted and osteoporotic fractures in any part of the humeral shaft, which allowed the early use of crutches and walking frames. Two nails were locked at only one end, and one of these became the only failure of union after an acute fracture.

Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period.

We report the results of locked Seidel nailing for 30 fractures of the humerus. There were frequent technical difficulties at operation especially with the locking mechanisms. Protrusion of the nail above the greater tuberosity occurred in 12 cases, usually due to inadequate locking, and resulted in shoulder pain and poor function. Poor shoulder function was also seen in five patients with no nail protrusion, presumably because of local rotator cuff damage during insertion. Our results suggest that considerable modifications are required to the nail, and possibly to its site of insertion, before its use can be advocated.

Intramedullary nailing of humeral shaft fractures in patients with multiple trauma

Intramedullary nailing of humeral shaft fractures in patients with multiple trauma