Clinical analysis of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children / 中华实用儿科临床杂志

ABSTRACT

Objective To discuss the clinical effect of three different approaches of elastic stable intramedullary nail for treatment of humeral shaft fractures in older children.Methods From January 2011 to December 2015,54 older children(31 males and 23 females) aged 8-14 years(average 11.4 years old) of humeral shaft fractures were treated in Children's Hospital of Nanjing Medical University with elastic stable intramedullary nail.The left side involved 24 cases and right involved 30 cases.Patients were divided into 3 groups according to different approachesbilateral retrograde group (31 cases),radial retrograde group (15 cases) and anterograde group (8 cases).Abduction brace was carried out postoperatively for about 6 weeks.Implant removal took place about 3-4 months later,when the X-ray showed fracture line disappeared and continuous trabecular bone was formed.A retrospective study was performed to compare the operation time,imaging findings after the surgery,fracture healing time and recent complications among the 3 groups.Results Bilateral retrograde nailing operation lasted for an average of (51 ±25) min and residual angle in X-ray films postoperative was (5.4 ± 1.8) °.The radial retrograde nailing average operating time was(46 ± 12)min and average residual angle in X-ray films postoperative was (12.8 ±2.9)°,while anterograde nailing was (44 ±16) min and (13.0 ± 3.6)°.The angle of the fracture after operation in the bilateral retrograde group was significantly less than those of the radial retrograde group and the anterograde group,and the difference was statistically significant (F =19.340,P ＜ 0.01).Children were followed up for 6 to 18 months (averaged 11 months).Each fracture was healed successfully.The excellent rates of Constant scores of postoperative shoulder joints 6 months after surgery were 96.8％ (30/31 cases),93.3％ (14/15 cases),87.5％ (7/8 cases).The excellent rates of Mayo scores of elbow joints 6 months after surgery were 93.5％ (29/31 cases),100.0％ (15/15 cases),100.0％ (8/8 cases).All fractures were healed without abnormal appearance or decreased range of motion.In terms of their complications,in the bilateral retrograde group,there was 1 case of iatrogenic ulnar nerve palsy and 5 cases with skin irritation.One case of skin irritation occurred in the radial retrograde group.Conclusions In treatment of humeral shaft fractures in older children,functional outcomes are similar in 3 groups.The technique of bilateral retrograde insertion is effective and has extensive applicability.