Intramedullary nailing of humeral shaft fractures |
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Authors: | W Schratz O Wörsdörfer C Klöckner C Götze |
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Institution: | Klinik für Unfallchirurgie und Orthop?die, Klinikum Fulda, XX
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Abstract: | Summary
Humeral shaft fractures can be treated either conservatively or operatively. Plating of the humerus is the established operative
method, but recently interest has also been focussed on intramedullary nailing. Fifty-nine cases of humeral fractures treated
with intramedullary nailing (Seidel/Marchetti-Vicenzi/Prévot) from January 1991 to December 1995 (44 fractures after trauma,
11 pathological fractures, 3 pseudarthroses, 1 re-fracture). Closed reduction in 55/59 cases. One infection (soft tissue);
2/48 pseudarthrosis (indication for nailing: pseudarthrosis!). No iatrogenic palsy of the radial nerve. Functional postoperative
treatment in all 44 cases of humeral fractures after adequate trauma. One poor functional result: periarticular ossification
after retrograde nailing, possibly connected with long-term respiratory treatment after trauma. Treatment of humeral shaft
fractures by intramedullary nailing is favoured in our clinic (low complication rates, excellent or good functional results,
limited approaches, small scars). Proximal fractures should be treated by the Seidel nail (stable interlocking of the proximal
fragment); very distal fractures need Prévot nailing (reaming of condylar canals). All other fractures of the humeral shaft
can be treated by each of the implants used in our clinic. Pathological fractures are an excellent indication for intramedullary
stabilization. These patients benefit from stable fixation without intense surgical trauma. Pseudarthrosis, according to our
limited experience, seems to require plating plus bone grafting. Plating is also recommended if revision of the radial nerve
becomes necessary.
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Keywords: | Humeral shaft fractures • Fracture fixation • Intramedullary fracture fixation • Prévot-nails • Radial nerve palsy |
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