Intramedullary nailing of humeral shaft fractures.
Twenty-one patients with 22 acute traumatic fractures of the humeral diaphysis were treated either with the True/Flex intramedullary rod or the Russell-Taylor rod. Follow-up is provided on 20 fractures. Indications for fixation on all but 3 patients was either multiple fractures, associated chest or abdominal trauma, vascular interruption, or open fracture. The series included 4 open fractures. Time to union averaged 7.6 weeks, with two nonunions, both in open fractures. Two isolated preoperative radial nerve palsies resolved fully; four brachial plexus injuries had a more complex recovery. No iatrogenic nerve damage was encountered. Excluding those patients with brachial plexus deficits, shoulder range of motion returned reliably. Impingement with a rod prominence was noted in 1 fracture. Functionally, all of the fractures, aside from those associated with a brachial plexus injury, had a normal or only mildly limiting result as reported by the patient. Additionally, eight humeral nonunions were treated with a reamed Russell-Taylor humeral nail with supplemental iliac crest bone graft at the time of nailing in 3 patients. Five of these 8 patients went on to union.
Sims
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Miller Orthopaedic Clinic, Charlotte, NC 28203, USA.
Smith
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D004551:Elbow Joint / Q000502:physiology; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005596:Fractures, Closed / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D009104:Multiple Trauma / Q000628:therapy; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000502:physiology