Fracture Shaft Humerus: Plating OR Nailing?
Abstract
Background: Conservative management of fracture shaft humerus yield in satisfactory results in most of the cases. Dilemma between dynamic compression plating and ante grade intra-medullary nailing occurs when a surgery is indicated.
Method: A total of 42 patients with fracture shaft humerus were treated surgically. 22 were subjected to plating and 20 were subjected to intra-medullary nailing. Functional outcome of patients were recorded using Constant and Murley score along with other parameters such as duration of surgery, intra-operative blood loss, complications and union time.
Results: Mean duration of surgery in plating group was 125.13 minutes and in the nailing group was 51.95 minutes. Average amount of blood loss in plating group was 209.09 ml and in nailing group was 60.5 ml. In the plating group 17 (77.27%) patients had complication free recovery period. 2 (9.09%) patients were found to have post-operative radial nerve palsy. 3 (13.63%) patients reported with superficial surgical site infection with wound dehiscence. In the nailing group 17 (85%) patients had uneventful recovery. 2 (10%) reported pain at shoulder and 1 (5%) patient complained of decreased abduction of shoulder at 1 year follow up. As per the Constant and Murley score, in the plating group 14 (63.63%) patients yielded excellent, 4 (18.18%) good, 2 (9.09%) fair and 2 (9.09%) poor results. Whereas, in the nailing group 14 (70%) patients yielded excellent, 4 (20%) good, 1 (10%) fair and 1 (10%) poor results. Mean radiological union time in plating group was 15.63 weeks and in the nailing group was 14 weeks.
Conclusion: Both intra-medullary nailing and dynamic compression plating are excellent methods for surgical fixation of shaft humerus fractures. Both of these methods yield in comparable results in terms of functional outcomes and union rates. Intra-medullary nailing holds edge over plating in terms of lesser blood loss, lesser operative time, shorter stay in hospital and less incidence of complications such as radial nerve palsy.
Downloads
References
Brinker MR, O'Connor DP. The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg Am. 2004; 86(2):290-7.
Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, Diamond B. Complications and hardware removal after open reduction and internal fixation of humeral fractures. Journal of Trauma and Acute Care Surgery. 2011; 70(5):1273-8.
Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S. Fractures of the shaft of the humerus an epidemiological study of 401 fractures. Journal of Bone & Joint Surgery, British Volume. 2006; 88(11):1469-73.
Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. Journal of Bone & Joint Surgery, British Volume. 1998; 80(2):249-53.
Sullivan R. The identity and work of the ancient Egyptian surgeon. J R Soc Med. 1996; 89 (8):467–473.
Klenerman L. Fractures of the shaft of the humerus. Journal of Bone & Joint Surgery, British Volume. 1966; 48(1):105-11.
Denard A, Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA. Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics. 2010; 33(8).
Rutgers M, Ring D. Treatment of diaphyseal fractures of the humerus using a functional brace. Journal of orthopaedic trauma. 2006 Oct 1; 20(9):597-601.
Templeman DC, Sims SA. Humeral shaft fractures. Surgical treatment of orthopaedic trauma. New York: Thieme Medical Publishers, Inc. 2007:263-84.
Bhandari M, Devereaux PJ, D Mckee M, H Schemitsch E. Compression plating versus intramedullary nailing of humeral shaft fractures—a meta-analysis. Actaorthopaedica. 2006 Jan 1; 77(2):279-84.
Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. Journal of orthopaedic trauma. 2000 Mar 1; 14(3):162-6.
Constant CR, Murley AG. A clinical method of functional assessment of the shoulder. Clinical orthopaedics and related research. 1987 Jan 1; 214:160-4.
Mauch J, Renner N, Rikli D. [Intramedullary nailing of humeral shaft fractures--initial experiences with an unreamed humerus nail]. Swiss surgery= SchweizerChirurgie= Chirurgiesuisse= Chirurgiasvizzera. 1999 Dec; 6(6):299-303.
Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated fractures of the humeral shaft. Journal of Trauma and Acute Care Surgery. 2000 Aug 1; 49(2):278-80.
Ingman AM, Waters DA. Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results. Journal of Bone & Joint Surgery, British Volume. 1994 Jan 1; 76(1):23-9.
WATANABE RS. Intramedullary fixation of complicated fractures of the humeral shaft. Clinical orthopaedics and related research. 1993 Jul 1; 292:255-63.
Hall RF, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am. 1987 Apr 1; 69(4):558-67.
Garcia A, Maeck BH. Radial nerve injuries in fractures of the shaft of the humerus. The American Journal of Surgery. 1960 May 31; 99(5):625-7.
KETTELKAMP DB, Alexander H. Clinical review of radial nerve injury. Journal of Trauma and Acute Care Surgery. 1967 May 1; 7(3):424-32.
Christensen NO. Kuntscher Intramedullary Reaming and Nail Fixation for Nonunion of the Humerus. Clinical orthopaedics and related research. 1976 May 1; 116:222-6.
Brumback RJ, Bosse MJ, Poka A, Burgess AR. Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg Am. 1986 Sep 1; 68(7):960-70.
Bolano L. E., Iaquinto J. A., Vasicek V. Operative treatment of humerus shaft fractures: A prospective randomized study comparing intramedullary nailing with dynamic compression plating. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons. 1995
Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. International orthopaedics. 2007 Jun 1; 31(3):391-5.
The entire contents of the Orthopaedic Journal of Madhya Pradesh Chapter are protected under Indian and International copyrights. Orthopaedic Journal of Madhya Pradesh Chapter allow authors to retain the copyrights of their papers without restrictions, Authors grant the publisher the right of exclusive publication. The Journal then grants to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, perform and display the work publicly and to make and distribute derivative works in any digital medium for any reasonable non-commercial purpose, subject to proper attribution of authorship. The journal also grants the right to make numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Non-commercial share alike 4.0 International Public License.
OAI - Open Archives Initiative
