Intramedullary nailing versus plating in shaft humerus fractures: a prospective randomized study

Authors

  • Nachiket Kailash Pansey Department of Orthopaedics, 1nant Institute of Medical Sciences, Jabalpur, Madhya Pradesh, India
  • Gaurav Mahesh Sharma Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India
  • Lokesh Gudda Naik Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India
  • Krishna Sudhakar Badgire Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India
  • Faisal Qureshi Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India
  • Vikas Jain Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20171905

Keywords:

Humerus fractures, Bone plates, Intramedullary nail

Abstract

Introduction- The two most commonly used modalities of internal fixation in fracture shaft of humerus are Plate osteosynthesis and Intramedullary nailing. The present study aims to analyze and compare both the techniques in terms of functional and radiological outcome. Material and Methods- 43 patients with diaphyseal fracture humerus were treated with Intramedullary nailing and plating between March 2015 and March 2016. The inclusion criteria were patients with closed diaphyseal fracture humerus. Compound fractures, pathological fractures, Non-union, mal-union fractures were excluded from the study. Results- 22 (51.2%) cases were operated using the antegrade nailing technique whereas dynamic compression plating was done in 21 (48.8%) cases. The mean age was 42±4.2 years. Road traffic accident was the most common mechanism of injury with 29 (67.5%) cases. 12-A2 type of fracture pattern were most common involving 23 (53.5%) cases. The mean surgical time was 68 mins in cases where nailing was done and 115 mins in cases with plating (P<0.001). Radiological union was seen at 13±4.8 weeks and 15±3.9 weeks in the nailing and plating group respectively. There were 2 (9.09%) cases in the nailing group and 1 (4.7%) case in the plating group which had delayed union. 3 (13.6%) cases in the nailing group had post-operative shoulder stiffness. The mean ASES score at the end of one year was 31.3 in nailing and

Background: The two most commonly used modalities of internal fixation in fracture shaft of humerus are plate osteosynthesis and intramedullary nailing. The present study aims to analyze and compare both the techniques in terms of functional and radiological outcome.

Methods: 43 patients with diaphyseal fracture humerus were treated with Intramedullary nailing and plating between March 2015 and March 2016. The inclusion criteria were patients with closed diaphyseal fracture humerus. Compound fractures, pathological fractures, non-union, mal-union fractures were excluded from the study.

Results: 22 (51.2%) cases were operated using the antegrade nailing technique whereas dynamic compression plating was done in 21 (48.8%) cases. The mean age was 42±4.2 years. Road traffic accident was the most common mechanism of injury with 29 (67.5%) cases. 12 A2 type of fracture pattern were most common involving 23 (53.5%) cases. The mean surgical time was 68 minutes in cases where nailing was done and 115 minutes in cases with plating (P <0.001). Radiological union was seen at 13±4.8 weeks and 15±3.9 weeks in the nailing and plating group respectively. There were 2 (9.09%) cases in the nailing group and 1 (4.7%) case in the plating group which had delayed union. 3 (13.6%) cases in the nailing group had post-operative shoulder stiffness. The mean ASES score at the end of one year was 31.3 in nailing and 29.6 in plating group (P =0.327). There were 37 (86.5%) cases with excellent to good results.

Conclusions: Nailing and plating have equal functional outcomes in cases with shaft humerus fracture.

29.6 in plating group (P=0.327). There were 37 (86.5%) cases with excellent to good results. Conclusion- Nailing and plating have equal functional outcomes in cases with shaft humerus fracture.

Author Biographies

Lokesh Gudda Naik, Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India

Sir HN Reliance Hospital

Faisal Qureshi, Department of Orthopaedics, Sir HN Reliance Hospital, Prarthana samaj, Girgaon, Mumbai, Maharashtra, India

Sir HN Reliance hospital

References

McKee MD. Fractures of The Shaft of The Humerus. In: Bucholz RW, Heckman JD, Court B, Lippincott CM, editors. Rockwood & Green’s Fractures in Adults. 6th Edition. 2006: 1118–59.

Brinker MR, O’Connor DP, Pierce P, Woods GW, Elliott MN. Utilization of orthopaedic services in a capitated population. J Bone Joint Surg Am. 2002;84(11):1926–32.

Klennermann L. Fractures of the shaft humerus. J Bone Joint Surg Br. 1966;48(1):105–11.

Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fracture. Results using AO plating techniques. J Bone Joint Surg Am. 1986;68(3):430-3.

McCormack RG, Brein D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of Fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg Br. 2000;82(3):336-9.

Pollock FH, Drake D, Bovill EG, Day L, Trafton PG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg Am. 1981;63(2):239-43.

Hall RF, Pankovich AM. Ender nailing of acute fractures of humerus. A study of closed fixation by intramedullary nails without reaming. 1987;69(4):558-67.

Rodriguez-Merchan EC. Compression plating versus Hackethal nailing in closed humeral shaft fractures failing non-operative reduction. J Ortho Trauma. 1995;9(3):194-7.

Bhandari M, Devereaux PJ, McKnee MD, Schemitsch EH. Compression plating versus intramedullary nailing of humeral shaft fractures- A Meta-analysis. Acta Orthop. 2006;77(2):279-84.

Gongol T, Mracek D. Functional therapy of diaphyseal fractures of the humeral bone. Acta Chir Orthop Traumatol Cech. 2002;69(4):248–53.

Heim D, Herkert F, Hess P, Regazzoni P. Surgical treatment of humeral shaft fractures, the basal experience. J Trauma. 1993;35(2):226–32.

Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated fractures of the humeral shaft. J Trauma. 2000;49(2):278–80.

Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J shoulder Elbow Surg. 2013;22(3):387-95.

Ma J, Xing D, Ma X, Gao F, Wei Q, Jia H, et al. Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis. Plos One. 2013;8(12):82075.

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Published

2017-04-25

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Original Research Articles