Titanium elastic nail fixation of diaphyseal humeral fracture in multiply traumatized adolescent and young adults

ABSTRACT

Non operative treatment is the mainstay in isolated humeral shaft fractures, as opposed to multiple trauma patients where operative stabilization is often necessary. Multiple methods of internal fixation of these fractures are in practice with no clear cut merits of one method over the other. This is a prospective study to review the clinical and functional outcome of fixing diaphyseal humeral fractures in adolescents and young adults with multiple trauma by titanium elastic nails. Diaphyseal humeral shaft fracture in eighteen multiply injured adolescent and young adult patients were treated with closed intramedullary titanium elastic nailing. Modified antegrade technique was used in 6 patients and retrograde technique was used in 12 patients. Average patient age was 26-years; and average follow-up duration was 17-months. The primary outcome measures were function and pain assessment at six months using the American Shoulder and Elbow Surgeons [ASES] score for 13 activities of daily living. Follow up of sixteen fractures showed that fourteen [88%] united primarily at an average of 10 weeks. Functional assessment at six months, using American Shoulder and Elbow Surgeons [ASES] score showed an average of 46 points. Secondary surgery was performed in two patients; one bone grafting for delayed union with eventual healing, and one patient had plating of fracture after development of a gap and soft tissue interposition. There was no deep infection or iatrogenic radial nerve injury. Closed stabilization of humeral shaft fracture by titanium elastic nail in this study provide a stable fixation, yielding overall good clinical and functional outcome in the multiply injured patient and served as simple, safe and fast procedure with minimal morbidity