title: Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures.
abstract: 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.
authors.affiliation: Department of Orthopaedics, Jawaharlal Nehru Medical College, KLES Hospital & Research Centre, Belgaum, Karnataka, India. amitputti@hotmail.com
authors.forename: Amit B
authors.initials: AB
authors.lastname: Putti
authors.forename: Rajendra B
authors.initials: RB
authors.lastname: Uppin
authors.forename: Babu B
authors.initials: BB
authors.lastname: Putti
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D016009:Chi-Square Distribution; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000601:surgery*; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome