Treatment of fracture of shaft of humerus in adults by intramedullary interlocking nail fixation

Backgroud: The optimal method of humeral shaft fracture fixation remains in debate. With the dramatic success of intramedullary fixation for fractures of the femur and tibia, there was speculation that IM-ILN might be more appropriate for humeral shaft fractures than DCP. There are very few studies comparing intramedullary interlocking nail and dynamic compression plating in fracture shaft of humerus and virtually no study in this part of world.Objective: The aim of the study was to assess the fixation of fracture shaft of humerus with interlocking nail and in terms of duration of operating time, amount of blood loss, rate of infection, pain at the fracture site,time to achieve union, functional outcome (DASH score), complications of surgery.Method: This was respective interventional study. All patients with fractures of shaft of humerus that met the criteria for operative interventions (intramedullary interlocking nail) presenting to the department of Orthopaedics BPKIHS over a period of 3 years from July 2006 to August 2009 and giving informed consent were included in the study. The study enrolled 30 patients.Result: Among 30 patients, 75% were male and 25% were female. The mean age of patients was 34.5 years. The usual mode of injury were road trafiic accident followed by fall from height, work place injury. Most of the patients were right handed. The operating time was 100 mins with standard deviation of 11.24. The mean blood loss was 148.75 with standard deviation of 36.70. Post operative hospital stay was 4.5 days. The peroperative radial nerve palsy was 4%. Radiologically, four cortices union was only 50% in 24 weeks post operative time. Dash score gradually improved in susequent followed up. Conclusion: It is concluded that dynamic compression plating is better in our study for fracture shaft of humerus. Plate osteosynthesis remains the gold standard of fixation for humeral shaft fractures.Health Renaissance 2015;13(2): 153-159

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Dynamic Compression Plate Versus Intramedullary Interlocking Nail for Managemaent of Humeral Shaft Fractures

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v3i2.9513 ◽

2014 ◽

Vol 3 (2) ◽

pp. 10-13

Author(s):

Pashupati Chaudhary ◽

Navin Kumar Karn ◽

Bikram Prasad Shrestha ◽

Guru Prasad Khanal ◽

Shivraj Paneru ◽

...

Keyword(s):

Blood Loss ◽

Dynamic Compression ◽

Operating Time ◽

Humeral Shaft ◽

Dash Score ◽

Interlocking Nail ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Plate Group ◽

Compression Plating

Introduction: With the dramatic success of intramedullary fixation for fractures of the femur and tibia, there was speculation that Intramedullary Interlocking Nails might be more appropriate for humeral shaft fractures in comparison to Dynamic Compression Plates. There are very few studies comparing these two methods of fixation in shaft of humerus fractures and virtually no study in this part of world. The aim of the study was to compare these fixation methods in terms of duration of operating time, amount of blood loss, rate of infection, pain at the fracture site, time to achieve union, functional outcome(DASH score) and complications of surgery. Methods: This was randamised control trial in which all patients with fractures of shaft of humerus that met the criteria for operative interventions ( intramedullary interlocking nailing and dynamic compression plating) presenting to the department of Orthopaedics BPKIHS during the study period and giving informed consent were included in the study. The patients were randomized using Excel random number generation technique into two groups. N Group: Cases treated with intramedullary interlocking nail and P Group: Cases treated with dynamic compression plate. Results: Most of the patients were right handed. The operating time for nailing was 100±11.24 minutess in comparision to 90.25± 15.6 minutes for humerus plating. The mean blood loss in nail group was 148.75 ±36.70 while in plate group blood loss was 205±45.60. Post operative hospital stay was similar in both groups with mean stay of 4.5 days.The peroperative radial nerve palsy was 4% in nailing group as compared to 2% in plating group. Radiologically four cortices union was only 50% in nailing group while it was 80% in plating group at 24 weeks post operatively. Dash score gradually improved in both nail and plate group but Dash score was significantly higher in plating group at 6,12,18 and 24 weeks follow up. Conclusion: Dynamic compression plating is better for fracture shaft of humerus. Plate osteosynthesis remains the gold standard of fixation for humeral shaft fractures. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9513 NOAJ July-December 2013, Vol 3, Issue 2, 10-13

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Randomized controlled trial comparing dynamic compression plate versus intramedullary interlocking nail for management of humeral shaft fractures

Health Renaissance ◽

10.3126/hren.v9i2.4974 ◽

1970 ◽

Vol 9 (2) ◽

pp. 61-66 ◽

Cited By ~ 2

Author(s):

P Chaudhary ◽

NK Karn ◽

BP Shrestha ◽

GP Khanal ◽

R Rijal ◽

...

Keyword(s):

Standard Deviation ◽

Blood Loss ◽

Functional Outcome ◽

Dynamic Compression ◽

Operating Time ◽

Humeral Shaft ◽

Dynamic Compression Plate ◽

Interlocking Nail ◽

Humeral Shaft Fractures ◽

Compression Plate

Background: The optimal method of humeral shaft fracture fixation remains debatable. With the dramatic success of intramedullary fixation for fractures of the femur and tibia, there was speculation that IM-ILN might be more appropriate for humeral shaft fractures than DCP. Objectives: To compare the fixation of fracture shaft of humerus with interlocking nail and dynamic compression plate in terms of duration of operating time, amount of blood loss, rate of infection, pain at the fracture site, time to achieve union, functional outcome (DASH score) and complications of surgery. Methods: This was randomised control trial study. All patients with fractures of shaft of humerus that met the criteria for operative interventions presenting to the Department of Orthopaedics, BPKIHS in the study period and giving informed consent were included in the study. Sample size was taken 30 in each group. Results: The usual mode of injury in both the groups were road traffiic accident followed by fall from height, work place injury. The operating time for nailing was 100 mins with standard deviation of 11.24 while that of humerus plating was 90.25 with standard deviation 15.6.The mean blood loss in nail group was 148.75 with standard deviation of 36.70 while that in plate group was 205.00 with standard deviation of 45.60. Post operative hospital stay was similar in both groups with mean stay of 4.5 days. DASH was significantly higher in plating group at 6,12,18 and 24 weeks follow up. This showed better functional outcome in nailing group. Conclusion: Dynamic compression plating is better than interlocking nail for fracture shaft of humerus. Keywords: shaft of humerus; interlocking nail; plate fixation DOI: http://dx.doi.org/10.3126/hren.v9i2.4974 Health Renaissance 2011: Vol.9 (No.2): 61-66

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Management of Humeral Shaft Fracture: A Comparative Study between Interlocking Nail and Dynamic Compression Plating

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v5i10.186 ◽

2017 ◽

Vol 5 (10) ◽

Author(s):

Dr Noorul Ameen1 ◽

Keyword(s):

Comparative Study ◽

Dynamic Compression ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Interlocking Nail ◽

Compression Plating ◽

Dynamic Compression Plating

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A prospective randomised control study on dynamic compression plating versus intra medullary interlocking nailing in humeral diaphyseal fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211388 ◽

2021 ◽

Author(s):

Muhammed Junaid Abdul ◽

Jojin Jose Chitten ◽

Ramasamy Balasubramaniam ◽

Rajamohan Rajesh

Keyword(s):

Functional Outcome ◽

Dynamic Compression ◽

Humeral Shaft ◽

Dash Score ◽

Interlocking Nailing ◽

Significant Difference ◽

Diaphyseal Fractures ◽

Control Study ◽

Compression Plating ◽

Dynamic Compression Plating

Background: Surgical fixation of humeral shaft fractures generally involves plating or nailing. Despite the extensive literature comparing outcomes after open reduction with internal fixation (ORIF) with plating and interlocking intramedullary nailing (ILIMN) for acute humeral diaphyseal fractures, the superior treatment strategy still remains controversial. The purpose of this study was to compare the functional outcome of each method of fixation (dynamic compression plating and interlocking nailing) for the shaft of humerus fracture and to analyse statistically significant difference in the results of these two methods in terms of functional outcome, rate of healing and complications.Methods: We conducted a prospective randomized control study and evaluated the results of 50 patients having humeral shaft fracture which were internally fixed with antegrade interlocking nailing (25 patients) and dynamic compression plating (DCP) plate (25 patients). Patients were followed up on average of 11.4 months and their radiological outcomes were assessed with plain radiography and with DASH score.Results: The plating group had statistically significant faster radiological healing and better DASH score compared to nailing group. Also, postoperative complication rate was higher in ILN group which was statistically significant.Conclusions: ORIF with DCP provides better results in terms of good functional outcome, faster radiological union and less post-operative complications compared to ILIM nailing. Hence, we concluded that plating is a superior option than nailing.

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Management of humeral shaft fracture: a comparative study between interlocking nail and dynamic compression plating

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20161457 ◽

2016 ◽

Author(s):

Golam Hashib

Keyword(s):

Dynamic Compression ◽

Sinus Tract ◽

Humeral Shaft ◽

Daily Activities ◽

Non Union ◽

Interlocking Nail ◽

Group A ◽

Group B ◽

Compression Plating ◽

Dynamic Compression Plating

Background: Fractures of humeral shaft are commonly encountered by orthopaedic surgeons accounting for approximately 3% of all fractures. Treatment of these injuries continues to evolve as advances are made in both operative and non-operative management. Most humeral shaft fractures can be managed non-operatively with anticipated good to excellent results.Methods: 29 cases with fracture of shaft of humerus were treated operatively in the Department of Orthopaedics, Katihar Medical College. Out of these, 15 cases (Group-A) underwent internal fixation by humeral interlocking nail and 14 cases (Group-B) underwent internal fixation by dynamic compression plating, with or without bone grafting. Bone grafting was done in 8 cases of Group-A and 5 cases of group-B.Results: All cases, except one from each group returned to their previous occupation. Both these cases developed non-union. They were able to perform daily activities but not able to resume their occupation. Thus the functional result was good in 92.3% of cases and poor in 7.7% of cases of either group. 4 cases in group-B (30.8%) managed by dynamic compression plating developed infections. In this study complications were also observed. Two of them were superficial infections that responded well to antibiotics and dressings and later healed well and united. Two cases developed discharging sinuses and subsequently infected union. Later the plate was removed and sinus tract excised. The sinus tract healed but left unsightly scar marks over the arm. Only one patient (7.7%) of group-A developed deep seated infection and subsequent non-union. 3 cases of group-A (23.1%) developed shortening ranging from 1.5cm to 4cm. All these cases were cases of old non-union with sclerotic bone ends which had to be nibbled and refreshed. Shortening developed in 2 cases (15.4%) of group-B. One non-union was seen in each group. While the screws of one dynamic compression (7.7%) went loose, no implant failure occurred in interlocking nails. One case (7.7%) of group-A developed axillary nerve injury, which might be attributed to the fact that the incision extended 6-7 cm beyond the acromion process. Only one case in group-B developed 10o angulation.Conclusions: Dynamic compression plating has stood the test of time as an excellent method of stabilizing transverse diaphyseal fractures of humerus. The plate produces a compression at the fracture site promoting osteosynthesis. But the technique is not suitable for segmental fractures, pathological fractures, communited fractures, gross osteoporosis, non-union and fractures much proximal or distal to shaft. Introduction of interlocking nailing has largely solved problems faced by the standard dynamic compression plating technique. An advantage of humerus interlocking is that even when non-union developed daily activities could be performed whereas in cases with loosening of screws it was difficult to do so.

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Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd005959.pub2 ◽

2011 ◽

Cited By ~ 22

Author(s):

Harish Kurup ◽

Munier Hossain ◽

J Glynne Andrew

Keyword(s):

Intramedullary Nailing ◽

Dynamic Compression ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Compression Plating ◽

Dynamic Compression Plating

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Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures: a meta-analysis of RCTs and nonrandomized studies

Journal of Orthopaedic Science ◽

10.1007/s00776-013-0497-8 ◽

2014 ◽

Vol 19 (2) ◽

pp. 282-291 ◽

Cited By ~ 20

Author(s):

Jiezhi Dai ◽

Yimin Chai ◽

Chunyang Wang ◽

Gen Wen

Keyword(s):

Intramedullary Nailing ◽

Dynamic Compression ◽

Meta Analysis ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Compression Plating ◽

Dynamic Compression Plating

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Locked Intramedullary Nailing versus Dynamic Compression Plating for Humeral Shaft Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700202 ◽

2009 ◽

Vol 17 (2) ◽

pp. 139-141 ◽

Cited By ~ 48

Author(s):

Amit B Putti ◽

Rajendra B Uppin ◽

Babu B Putti

Keyword(s):

Intramedullary Nailing ◽

Functional Outcomes ◽

Dynamic Compression ◽

Adhesive Capsulitis ◽

Humeral Shaft ◽

Complication Rates ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Compression Plating ◽

Dynamic Compression Plating

Purpose. To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. Methods. 32 men and 2 women with humeral shaft fractures were randomised to undergo locked antegrade intramedullary nailing (IMN, n=16) or dynamic compression plating (DCP, n=18). Patients with pathological fractures, grade-III open fractures, neurovascular injury, or fractures for more than 2 weeks were excluded. Fractures were classified according to the AO classification system (one in A1, 6 in A2, 12 in A3, 6 in B1, and 9 in B2). 28 were injured in road traffic accidents. The functional outcome (according to the American Shoulder and Elbow Surgeons [ASES] score) and rates of union and complication of the 2 groups were compared. Results. All patients were followed up for a minimum of 24 months. In the respective IMN and DCP groups, the mean ASES scores were 45.2 and 45.1 (p=0.69), the complication rates were 50% and 17% (p=0.038), and the non-union rates were 0% and 6% (p=0.15). In the IMN group, 2 sustained iatrogenic fractures during nail insertion; 2 had transient radial nerve palsies; one underwent nail removal for shoulder impingement; and 3 had adhesive capsulitis. In the DCP group, one underwent re-operation for implant failure; one had a superficial infection; and one developed adhesive capsulitis. Conclusion. The complication rate was higher in the IMN group, whereas functional outcomes were good with both modalities.

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