Prospective study on the closed interlocking humerus nailing in comminuted and segmental humerus fractures

Ashok, S (2010) Prospective study on the closed interlocking humerus nailing in comminuted and segmental humerus fractures. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Fracture shaft of humerus constitutes 3 % of all bony injuries. The uniqueness in the anatomy, the fracture configuration and the functional significance of the region influences the treatment options. The humerus is covered by sleeve of muscles and has rich vascularity which helps in fracture healing. The mobility of the shoulder and the elbow joint accommodates for a minimal degree of angulation and shortening. Moreover the limb does not take part in weight bearing or ambulation; hence some amount of shortening is functionally acceptable. But rotational deformity is not tolerated well. Open reduction and internal fixation with plate osteosynthesis has been gold standard for treatment of fractures of the humeral diaphysis. Intramedullary fixation devices have been used very effectively in the treatment of lower limb fractures. Interlocking nailing done with closed reduction has definite advantages over plate osteosynthesis in indicated cases. AIM: To analyse the outcome of closed interlocking Humerus nailing in comminuted and segmental Humerus fractures. MATERIALS AND METHODS: Our study was conducted in the Institute of Orthopaedics and Traumatology, Madras Medical College from August 2007 to September 2009. It is a case series of 23 diaphyseal fractures in 22 patients. One patient died in the postoperative period and two patient was lost in the follow up so were excluded from the study. Selection Criteria - 1. Comminuted fractures, 2. Segmental fractures, 3. Polytrauma, 4. Age more than 17 years when the physis is fused, 5. The fracture line is 3 cms beyond the surgical neck and 4 cms from the olecranon fossa, 6. compound fractures. Exclusion Criteria - 1. Presence of open physis, 2. Grossly contaminated compound fractures, 3. Fractures involving the proximal 3 cms and the distal 4 cms of the diaphysis. RESULTS: The results of the use of intramedullary interlocking nailing for the diaphyseal fractures of the humerus has been mixed, with some studies showing good outcome and some showing not so good outcome. In most studies a significant percentage of patients do not return for follow up once the limb is functional and painless40. Non union and functional disability of the shoulder are the most common complaints in most patients postoperatively in many series. Post operative mobilization of the shoulder and elbow was very critical in attaining the amount of movements of the shoulder. Patients who adhered to the mobilization programme had a better functional result compared to others. CONCLUSION: Locked intramedullary nailing is a novel treatment option for diaphyseal fractures of the humerus. It is ideal in treating diaphyseal fractures of the humerus in patients with osteoporosis and polytrauma where reduction in operating time and early rehabilitation are primary objective. It also useful in comminuted and segmental humeral fractures wherein done by closed method, the periosteum is not stripped and the fracture haematoma not violated leading to better and faster fracture healing. The concept of biological fixation in terms of unreamed nailing, closed reduction, static locking and fracture site compression promotes early and adequate fracture union. Locked intramedullary nailing is an alternative in treating patients with pathological fractures of humerus. Locked humeral intramedullary nailing is an effective and safe alternative for the treatment of diaphyseal humeral fractures. It is suitable for treatment in patients with comminuted, segmental, polytrauma, osteoporosis and pathological fractures. It provides early rehabilitation and lessens morbidity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective study ; closed interlocking humerus nailing ; comminuted ; segmental humerus fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 02:40
Last Modified: 14 Sep 2017 02:40

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