Details
Category: Volume 05 Issue 10 October 2017
Hits: 1156

Title: Management of Humeral Shaft Fracture: A Comparative Study between Interlocking Nail and Dynamic Compression Plating

Authors: Dr Noorul Ameen, Dr Raja Anurag Gautam, Dr Mehamil K.V.

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.186

Abstract

Background: Humeral shaft fractures are commonly seen by orthopaedic surgeons accounting for about 3% of all fractures. Advancement has been made in both operative and non-operative management. Most humeral shaft fractures can be managed non-operatively with good results.

Methods: 29 cases with fracture of shaft of humerus were treated operatively. Out of these, 15 cases (Group- A) undergone internal fixation by humeral interlocking nail and 14 cases (Group -B) undergone internal fixation by dynamic compression plating, with or without bone grafting. Bone grafting were done in 8 cases of Group-A and 5 cases of group-B.

Results: All cases, except one from each group not returned to their previous occupation. Both of these cases developed non-union. They were able to do day to day activities but not able to do their occupation.2 cases from group A and one from group B were lost during follow up. Thus the functional result was good in 92.3% (12 out of 13 cases) of cases and poor in 7.7% (1 out of 13 cases) of cases of the either group. 4 cases in group-B (30.8%) managed by dynamic compression plating developed infections later. In this study complications were also observed. Two of them were superficial infections that responded well after giving antibiotics and dressings and later healed better and united. Both cases developed discharging sinuses and subsequently infected union. Later the removal of plate was done and sinus tract was excised. The sinus tract was healed with unsightly scar marks. Only one patient (7.7%) of group-A developed deep infection and subsequent non-union. 3 cases of group-A (23.1%) developed shortening ranging from 1.5cm to 4cm. All these cases were cases of old non-union with sclerotic bone ends which had to be nibbled and refreshed. Shortening developed in 2 cases (15.4%) of group-B. One non-union were seen in each group. While the one of the screws of dynamic compression (7.7%) went loose, no implant failure seen in interlocking nails. One case (7.7%) of group-A developed axillary nerve injury, which might be attributed to the fact that the incision extended 6-7 cm beyond the acromion process. Only one case in group-B developed 10 degree angulation.

Conclusions: Dynamic compression plating is the excellent method of stabilizing transverse diaphyseal fractures of humerus. The compression produced at the fracture site by the plate promoting osteosynthesis. But the technique is not suitable for segmental fractures, pathological fractures, communited fractures, gross osteoporosis, non-union and fractures much proximal or distal to shaft. Introduction of interlocking nailing has largely solved problems faced by the standard dynamic compression plating technique. An advantage of humerus interlocking is that even after developing non union day to day activities could be performed whereas in cases with loosening of screws it was difficult.

Keywords: Dynamic compression plate, Fracture, Humerus, Interlocking nail.

References

  1. Laing PG. The arterial supply of the adult Humerus. J Bone Joint Surg. 1956;38: 1105-16.
  2. Carrol SE. A study of the nutrient foramina of the humeral diaphysis. J Bone Joint Surg. 1956;38:1105-16.
  3. Klenerman L. Fractures of shaft of the humerus. J Bone Joint Surg. 1966;48:105-11.
  4. Bailfour GW, Mooney V, Ashby ME. Diaphyseal fractures of the humerus treated with a readymade fracture brace. J Bone Joint Surg. 1982;64:11-3.
  5. Brumback RJ, Bose MJ, Poka A, Burgess AR. Intramedullary stabilisation of humerus shaft fractures in patients with multiple trauma. J Bone Joint Surg. 1986;68:960-70.
  6. Mast JW, Spiegel PG, Harvey JP, Harrison C. Fractures of the humeral shaft. Clin Orthop. 1975;12:254-62.
  7. Sarmiento A, Kinman P, Galvin E. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg. 1977;59:596-601.
  8. Stewart MJ, Hundley JM. Fracture of the humerus: A comparative study in methods of treatment. J Bone Joint Surg. 1955;37:681-39.
  9. Bhalla R, Narang TS, Lobo LH. Functional brace treatment of the fracture of the shaft of the humerus. Ind J of Orthop. 1982;1(6):25-8.
  10. Bhandari M, Devereaux PJ, McKee MD. Compression plating versus intramedullary nailing of humeral shaft fractures-a meta-analysis. Acta Orthop. 2006;77:279.
  11. Ivan RF, Peter K. Open reduction and internal fixation of humeral non-unions. J Bone Joint Surg. 2002;84(8):1315-22.
  12. Liang HT. Treatment of non-union of humeral shaft fracture with dynamic compression plate and cancellous bone graft. J Chin Med Assoc. 2005;68(2):73-6.
  13. McKee MD. Fractures of the shaft of the humerus. In: Bucholz RW, Heckman JD, Court-Brown CM eds. Rockwood and green’s fractures in adults. Philadelphia, Lippincott Williams and Wilkins; 2006.
  14. Lin J, Hou SM. Treatment of humeral shaft delayed unions and non-unions with humeral locked nails. J Trauma. 2000;48:695-703.
  15. Dijkstra S, Wiggers T, Boxma H. Impending and actual pathologic fractures in patients with bone metastasis of the long bones. A retrospective study of 233 surgically treated fractures. Eur J Surg. 1994;160:535-42.
  16. Tom EJ, Carsi D, Garcia C, Marco F. Treatment of pathologic fractures of the humerus with seidel nailing. Clin Orthop. 1998;350:51-5.
  17. Damron TA, Rock MG, Choudhary SN, Grabowski JJ. Biomechanical analysis of prophylactic fixation for middle third humeral impending pathological fractures. Clin Orthop. 1999;363:240-8.
  18. Dabezeis EJ, Banta CJ, Murphy CP, Ambrosia RD. Plate fixation of the humeral shaft for acute fractures with and without radial nerve injuries. J Orthop Trauma. 1992;6(1):10-3.
  19. Wright TW, Miller GJ. Reconstruction of the humerus with an intramedullary fibular graft. J Bone Joint Surg. 1993;75:804-7.
  20. Habernek H, Schrmid Z, Orthner E. Initial experiences with humerus interlocking nail. Unfall Chirurgie. 1992;18(4):233-7.
  21. Guse TR, Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop Relat Res. 1992;320:149-53.
  22. Strong GT. The epidemiology of humeral shaft fractures. J Bone Joint Surg. 1998;80:249-53.
  23. Chapman JR, Bradford HM. Randomized prospective study of humeral shaft fracture fixation: Cite this article as: Hashib G. Management of humeral shaft fracture: a comparative study between interlocking nail and dynamic compression plate. Int J Res Orthop 2016;2:40-7. intramedullary nails versus plates. J Orthop Trauma. 2000;14:162-6.
  24. McCormack RG, Brien D, Buckley RE, McKee MD. Fixation of fracture of the shaft of humerus by dynamic compression plate or intramedullary nail. J Bone Joint Surg. 2000;82:336-9.
  25. Gupta R, Raheja A, Sharma V. Limited contact dynamic compression in diaphyseal fractures of the humerus. Acta Orthop Scand. 2000;71:471-4.
  26. Sarmiento A, Jagorski JB, Zych GA. Functional bracing for the treatment of the fractures of humeral diaphysis. J Bone Joint Surg. 2000;82:478-86.
  27. Koch PP, Gross DF, Gerber C. The results of functional bracing of humeral shaft fractures. J Shoulder Elbow Surg. 2002;11:143-50.
  28. Sarmiento A, Latta LL. Conservative treatment of humeral shaft fractures. Unfallchirug. German Trauma Assoc. 2007;110:824-32.
  29. Paris H, Tropiano P, Clouet B, Chaudet H, Poitout DG. Fractures of the shaft of humerus: systemic plate fixation. J Bone Joint Surg. 2000;82:336-9.
  30. Ajmal M, McCabe J. Antegrade locked intramedullary nailing in humeral shaft fractures. Injury. 2001;32:692-4.
  31. Flinkkila T, Hyvonen P, Siira P, Hamalainen M. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg. 2004;124:537-41.
  32. Kesemenli CC, Subasi M, Arslan H, Necmioqlu, Kapukaya A. Comparison between nailing and compression plating of humerus fractures. Acta Orthop Trauma Turc. 2003;37(2):120-5.

Corresponding Author

Dr Noorul Ameen

Junior Resident, Sree Balaji Medical College & Hospital,

Chrompet, Chennai-44