Experience with interlocking nail fixation for humeral shaft fractures and its surgical spectrum

ABSTRACT

This is a prospective study of 23 patients who had 23 fractures of the humeral shaft fixed with closed unreamed interlocking nailing using the Russell-Taylor humeral nails. All fractures were of traumatic origin and of different morphological varieties The fractures occured at different levels of the humeral shaft extending from a point one inch distal to the inferior margin of the articular surface of the proximal humerus to a point two inches above the superior margin of the olecranon fossa. A closed technique of nailing was followed in all cases over a guide wire inserted in an antegrade manner into the medullary canal of the humerus after reduction of the fracture. There was no attempt at reaming the medullary canal and the used nail was of 8 mm diameter. In all cases but two the nail was locked at either end using a self tapping 4 mm cortical screw. Union was assessed radiologically by denoting bridging callus at the fracture site. In all cases but two healing progressed steadily. These two cases showed some delay in union but eventually united without further interventions. The average time of union was 16 weeks. The complications in this series was pain and limitation of shoulder movement in five patients, one of them also had limitation of elbow extension. latrogenic radial nerve palsy that recovered at 14 weeks postoperatively occurred in one patient, delayed union in two patients and few technical pitfalls related to the nail length and diameter or the locking screws occured in 6 patients. This study has shown that the technique of closed and locked medullary nailing of humeral shaft fractures is a reliable one. The rate of union is quite satisfactory if the technique and principles of the procedure are followed properly. Most important however is the wide spectrum of use of this technique that includes all sorts of fractures that extend from one inch below the humeral head to less than two inch above the olecranon fossa [Fig. 14]