DCP with intramedullary interlocking nails; compare the outcome in closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3

ABSTRACT

The objectives of the study are to compare the outcome of dynamic compression plates with intramedullary nails in closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3. Comparative study. Study was carried out at the Orthopaedics Unit-I, Liaquat University Hospital Hyderabad / Jamshoro, from March 2007 to Feb 2009. Study consisted of 40 patients of diagnosed cases of closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3. Patients were divided in two groups. Group A for dynamic compression plates and group B for intramedullary nails. Detailed Clinical examination of the patient was done and recorded in proforma. Systemic review was also done to see any major or minor head injury. All patients underwent for base line investigation. In Inclusion criteria; patients with type A1-2, A2-2 and A3-2 closed diaphyseal humeral shaft fracture, bilateral fractures, associated with minor head injuries, age between 20-40 years and fracture not more than two weeks old. In Exclusion criteria ; Open fracture, associated with severe chest or abdominal injuries, pathological fractures and malunited fractures with neurological deficit. Follow up of all these patients was done .1st four visit after every week, then alternet week upto 3rd month then monthly upto 6 month to assess any complication. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software version 16.0. In both groups male were 35[87.5%] and female 5[12.5%] with male Female Ratio of 71. There was wide variation of age ranging from a minimum of 20 year to 40 year in both group. The mean age was 29.78+3.5 years. The most common cause of fracture shaft of humerus was road traffic accident [RTA]. There were 23[57.5%] patients who sustained fractures of the humerus following road traffic accidents. Eight [20%] cases had fractures shaft of humerus after fall from height and 9 [22.5%] cases had fractures shaft after assault. The Fracture pattern was Oblique in 22[55%] cases, Transverse in 12[30%] and Spiral in 6[15%]. Severity of post operative pain in both groups was recorded. Mild pain was felt in 10[50%] patients of DCP group and 6 [30%] patients of IMN group, Moderate pain was seen in 7[35%] patients of DCP group and 10 [50%] patients of IMN group, severe pain was described by 3[15%] patients in DCP group and 4 [20%] patients in IMN group. The complications seen in this study were Infection [1[5%] patients in DCP VS 0[0%] patients in IMN group], Iatrogenic palsy of radial nerve [1[5%] patients in DCP VS 0 [0%] patients in IMN group], Non union [1[5%] patients in DCP VS 1 [5%] patients in IMN group],Severe impingement [0[0%] patients in DCP VS 3 [15%] patients in IMN group], Adhesive capsulitis [0[0%] patients in DCP VS 2 [10%] patients in IMN group]. However minimal loss of fixation in 1 [5%] cases and late fracture occurred in one case 5%. The duration of hospital stay varied from 1 to 20 days. It was longer about -10-20 days in 12[60%] of DCP patients as compared to IMN cases where majority 11[55%] were discharged within 1 to 10 days. The mean hospital stay in DCP group was 15 days and IMN group was 13.5 days. Dynamic compression plate is a safe and effective procedure for treatment of humeral shaft fractures. With low threshold of complications it has significant advantages over intramedullary nails procedure revealed with earlier mobilization, minimum hospitalization and fast recovery towards normal life