Closed retrograde locked nailing of the diaphyseal humeral fractures

ABSTRACT

Locked intramedulary nailing of humeral shaft fractures combines the advantages of intramedulary nailing with the added fixation of locked principles allowing for the extension of indications of interlocked nailing as in comminuted fractures. Also the interlocking nailing is superior to plating of diaphyseal fractures as it is a load sharing and control of bending stresses. In addition, the closed technique preserves the soft tissue blood supply and the fracture haematoma preserving the biologic process of fracture healing undisturbed. With retrograde technique most of the complications related to the shoulder joint and rotator cuff violation can be avoided. Fourteen patients with humeral shaft fractures had been treated by retrograde closed locked nailing using interlocking humeral nails. The average follow up period was four months [range from 3 to 10 months]. The average healing time of all fractures was eight weeks. After consolidation, the elbow function was excellent in twelve patients [85.7%], the shoulder function was excellent in thirteen patients [92.9%]. The functional end results were excellent in nine patients [64.2%], good in three patients [21.4%], fair in one patient [7.1%], and poor in one patient [7.1%]. Two patients [14.2%] had postoperative radial nerve palsy. There was comminution at the fracture site in three cases. There was one case [7.1%] of deep infection. Two patients [14.2%] had shortening and one case [7.1%] had varus deformity. There were no cases with implant failure. We concluded that closed retrograde locked nailing of fractures of the humeral shaft is an excellent method of fixation with added benefit over antegrade nailing that it does not affect the shoulder movement or disturb the rotator cuff insertion site