Functional Outcome of Interlocking Intramedullary Nailing of Fracture Shaft of Humerus: A Prospective study

Thirunarayanan, V (2009) Functional Outcome of Interlocking Intramedullary Nailing of Fracture Shaft of Humerus: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Fractures of the shaft of humerus account for approximately 3-5% of all fractures treated. Historically humeral shaft fractures have been classified by fracture location, fracture pattern, associated soft tissue injuries and quality of bone. This fracture has been treated by closed reduction & cast application with/without cast bracing and open reduction & internal fixation using dynamic compression plate. Many authors have documented the general good outcome that occurs after compression plate fixation, which is still considered the gold standard for operative treatment of acute humeral shaft fractures. Though plate fixation has given high rates of union, it involves extensive soft tissue stripping, potential injury to radial nerve and poor fixation in osteoporotic bone. Later flexible nails of many varieties were used. The advantages of intramedullary nailing are minimal surgical exposure, better biological fixation, minimal disturbances of soft tissues and early mobilization of neighboring joints. The technique of interlocking nailing represents the newer approach of the treatment of humeral fractures. Interlocking nailing also avoids complications like lack of rotational control, migration of nail and requirement of supplementary bracing. The Seidel nail was the first nail to be tested clinically. Eventually several nail systems evolved. AIM OF THE STUDY: The aim is to prospectively study the “functional outcome of interlocking intramedullary nailing in acute fractures and non-union of the diaphysis of humerus” , at the Department of Orthopaedics and Traumatology , Government Kilpauk Medical College, Chennai. MATERIALS AND METHODS: This is a prospective study of 20 Humeral diaphyseal fractures treated by Interlocking intramedullary nailing conducted for a period of 20 months from March 2007 to November 2008 at the Department of Orthopaedics, Government Kilpauk Medical College Hospital . Inclusion Criteria - • Acute shaft of humerus fractures, • Fracture Non-union, • 2cm below surgical neck to 3 cm above olecranon fossa, • Age above 18 years, • Pathological fractures, • Osteoporotic bone, • Polytrauma, • Neurovascular involvement, • Angulation more than 15 degrees after closed reduction, • Non compliance. Exclusion Criteria - 1. Presence of open physis, 2. compound fractures of more than Grade-I severity, 3. fracture involving proximal 2cms and distal 3cms of the diaphysis. RESULTS: Of the twenty cases in our study which was carried out from march 2007 to November 2008 1 patient died and 2 lost follow up. All cases were followed upto a period of maximum of 20 months and a minimum of three months on an average of 10 months. Of the 2 cases that lost follow up 1 case was an acute fracture of the humeral diaphysis and the other was a case of non-union fracture shaft of humerus. The outcome was studied based on the Rodriguez-Merchan's scoring system. CONCLUSION: Inter locking nailing of humerus is a safe and good alternative to treat acute fractures and non – union of the diaphysis. • The union rate is very good and comparable to that of Plateosteosynthesis. • The infection rate is very minimal • Intraoperative blood loss is less. • Chances of iatrogenic Radial N injury is less • Lesser malalignment. • Rotationally stable and cosmetically appealing. • Shoulder stiffness can be prevented with early fixation and proper rehabilitation protocol.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional Outcome of Interlocking Intramedullary Nailing ; Fracture Shaft of Humerus ; Prospective Study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:08
Last Modified: 17 Sep 2017 16:31
URI: http://repository-tnmgrmu.ac.in/id/eprint/2976

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