ABSTRACT
PURPOSE OF THE STUDY: We assessed outcome after intramedullary interlocking nailing for humeral fractures to identify problems and indications in comparison with reports in the literature. MATERIAL AND METHODS: We implanted the Russel and Taylor nail to treat 38 fresh humeral shaft non-pathological fractures using 33 anterograde insertions and 5 retrograde insertions. RESULTS: All patients were examined at a mean follow-up of 16.3 months. Problems and complications involved 3 open procedure conversion, 3 peroperative re-fractures, 2 locking errors, 2 secondary dismantelings, 2 regressive iatrogenic palsies, and 4 cases of pain due to protruding material. First intention bone healing was achieved in 34 cases and following a revision procedure in 2. Two cases of nonunion were not reoperated. The Neer and Constant scores, used to assess functional outcome, identified 5 non-satisfactory results. DISCUSSION: The risk of infection with locking nails is low, as is the risk of nervous complications which are generally related to traction manoeuvres during reduction. Bone healing is easily achieved if the assembly is perfectly stable. The risk of disassembly or nonunion is related to technical errors: defective locking, insufficient hold in the bone fragments. The risk of stiffness or rotator cuff tears is low, generally related to protrusion of the material and not to insertion through the cuff muscles. Retrograde insertion can be recommended for fractures of the distal third of the humeral shaft. CONCLUSION: Insertion of the Russel and Taylor intramedullary locking nail requires a learning curve to minimize the risk of iatrogenic complications. It can be proposed for fractures of the mid-third of the humeral shaft and can be discussed for the proximal and distal thirds if perfect stability can be obtained on the short bony fragment.
