Locked nailing of severely comminuted or segmental humeral fractures

Some comminuted or segmental humeral fractures have been well-treated by functional bracing, but some also have been reported to have a bad outcome. If surgery is required, unlocked nailing has the disadvantage of unstable fixation, and plating has the disadvantage of extensive soft tissue injury. In the current study, closed locked nailing was used to treat 23 Orthopaedic Trauma Association Type C humeral fractures (C1, five; C2, three; C3, 15). The patients were 12 men and 11 women with a mean age of 42.4 years. There were 16 closed fractures and four Type I, two Type II, and one Type IIIA open fractures. Eight fractures were in the proximal third, seven in the middle third, and eight in the distal third. With one nailing, 21 of 23 (91%) fractures achieved solid union in an average of 13.2 weeks. The two nonunions eventually united after another revision nailing and bone grafting. No patients had significant impairment of elbow function. Excellent or satisfactory shoulder function was obtained in 20 patients. Closed locked nailing showed reliable treatment results for severely comminuted or segmental humeral fractures. The keys to success include compression of the fractures, static locking, postoperative external support, and experienced surgical technique.