title: Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases.
abstract: Antegrade intramedullary nailing with four different implants was used in 126 humeral shaft fractures. There were 74 acute fractures, 17 pathologic fractures, 16 fractures malaligned in a hanging cast or brace, 15 fractures with delayed union and 4 fractures that were nailed after failed open reduction and internal fixation. The nonunion rate was 21/95 after primary operation, and after reoperations 14/95. Distraction of the fracture was a significant cause of nonunion, but not type of fracture, localization, implant, and delay between injury and surgery. Shoulder joint function was significantly impaired in 25/67 patients. The patients regarded the result as good or satisfactory in 41/67 of the cases who were followed mean 3 (0.5-10) years. We conclude that antegrade intramedullary nailing of humeral shaft fractures leads to a substantial risk of non-union and impairment of shoulder function. It can be recommended as primary treatment only when nonoperative treatment is likely to fail.
authors.affiliation: Oulu University Hospital, Department of Surgery, Finland. Tapio.Flinkkila@oulu.fi
authors.forename: T
authors.initials: T
authors.lastname: Flinkkilä
authors.forename: P
authors.initials: P
authors.lastname: Hyvönen
authors.forename: M
authors.initials: M
authors.lastname: Lakovaara
authors.forename: T
authors.initials: T
authors.lastname: Linden
authors.forename: J
authors.initials: J
authors.lastname: Ristiniemi
authors.forename: M
authors.initials: M
authors.lastname: Hämäläinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome