International Orthopaedics

, Volume 29, Issue 2, pp 88–91 | Cite as

Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails

  • Ting-Cheng Chao
  • Wen-Ying Chou
  • Jui-Chang Chung
  • Chien-Jen Hsu
Original Paper

Abstract

Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35–110) min; less mean blood loss, 70 (30–170) ml and shorter mean hospital stay, 5.8 (3–12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.

Résumé

Entre janvier 1991 et décembre 2002 nous avons traité chirurgicalement 92 fractures diaphysaires humérales fermés déplacés ( classification AO type A). Nous avons utilisé trois méthodes de fixation: plaque à compression dynamique (DCP) chez 36 malades, clou de Ender (EN) chez 32 malades et clou verrouillé (ILN) chez 24 malades. Les malades ont été suivis pendant un minimum de 24 mois. Àprés un an toutes les fractures sauf deux avaient consolidé (un DCP/un ILN). Les Malades traité avec EN ont eu un temps d’opération moyen plus court, 51 (35–110) min, une perte sanguine plus faible, 70 (30–170) ml et un plus court séjour à l’hôpital , 5.8 (3–12) jours. Il y avait trois paralysies iatrogènes du nerf radial, deux dans le groupe DCP et une dans le groupe ILN. Il y avait une infection. Il y avait trois cas avec un conflit de l’épaule mais l’amplitude de mouvement a été restauré après ablation du clou. Pour les malades avec multiples traumatismes ou risque opératoire élevé, l’enclouage de Ender est une procédure plus sûre et plus rapide. L’enclouage verrouillé a permit une fixation stable par une plus petite incision, mais avec un risque plus grand de comminution de la fracture.

References

  1. 1.
    Ajmal M, O’Sullivan M, McCabe J, Curtin W (2001) Antegrade locked intramedullary nailing in humeral shaft fractures. Injury 32:692–694CrossRefPubMedGoogle Scholar
  2. 2.
    Chapman JR, Henley MB, Agel J, Benca PJ (2000) Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 14:162–166CrossRefPubMedGoogle Scholar
  3. 3.
    Chen CM, Chiu FY, Lo WH (2000) Treatment of acute closed humeral shaft fractures with ender nails. Injury 31:683–685CrossRefGoogle Scholar
  4. 4.
    Chen AL, Joseph TN, Wolinksy PR, Tejwani NC, Kummer FJ, Egol KA, Koval KJ (2002) Fixation stability of comminuted humeral shaft fractures: locked intramedullary nailing versus plate fixation. J Trauma 53:733–737Google Scholar
  5. 5.
    Chiu FY, Chen CM, Lin CFJ, Lo WH, Huang YL, Chen TH (1997) Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma 43:947–951PubMedGoogle Scholar
  6. 6.
    Fernandez FF, Matschke S, Hulsenbeck A, Egenolf M, Wentzensen A (2004) Five years’ clinical experience with the undreamed humeral nail in the treatment of humeral shaft fractures. Injury 35:264–271CrossRefGoogle Scholar
  7. 7.
    Flinkkila T, Hyvonen P, Lakovaara M, Linden T, Ristiniemi J, Hamalainen M (1999) Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand 70:133–136PubMedGoogle Scholar
  8. 8.
    Hall RF, Pankovich AM (1987) Ender nailing of acute fractures of the humerus. J Bone Joint Surg Am 69:558–567Google Scholar
  9. 9.
    Kumar A, Sadiq SA (2002) Non-union of the humeral shaft treated by internal fixation. Int Orthop 26:214–216Google Scholar
  10. 10.
    Liebergall M, Jaber S, Laster M, Abu-Snieneh K, Mattan Y, Segal D (1997) Ender nailing of acute humeral shaft fractures in multiple injuries. Injury 28:577–580CrossRefGoogle Scholar
  11. 11.
    Lin J (1998) Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma 44:859–864PubMedGoogle Scholar
  12. 12.
    Lin J, Hou SM (2003) Locked nailing of severely comminuted or segmental humeral fractures. Clin Orthop 406:195–204Google Scholar
  13. 13.
    Lin J, Shen PW, Hou SM (2003) Complications of locked nailing in humeral shaft fractures. J Trauma 54:943–949PubMedGoogle Scholar
  14. 14.
    Martinez AA, Cuenca J, Herrera A (2004) Treatment of humeral shaft nonunions: nailing versus plating. Arch Orthop Trauma Surg 124:92–95CrossRefGoogle Scholar
  15. 15.
    McCormack RG, Brien D, Buckley RE, Mckee MD, Powell J, Schemitsch EH (2000) 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 82:336–339CrossRefPubMedGoogle Scholar
  16. 16.
    Rodriguez-Merchan EC (1996) Hackethal nailing in closed transverse humeral shaft fractures after failed manipulation. Int Orthop 20:134–136Google Scholar
  17. 17.
    Sanzana ES, Dümmer RE, Castro JP, Díaz EA (2002) Intramedullary nailing of humeral shaft fractures. Int Orthop 26:211–213Google Scholar
  18. 18.
    Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82:478–486CrossRefGoogle Scholar
  19. 19.
    Simon P, Jobard D, Bistour L, Babin SR (1999) Complications of Marchetti locked nailing for humeral shaft fractures. Int Orthop 23:320–324Google Scholar
  20. 20.
    Wallny T, Sagebiel C, Westerman K, Wagner UA, Reimer M (1997) Comparative results of bracing and interlocking nailing in the treatment of humeral shaft fractures. Int Orthop 21:374–379CrossRefPubMedGoogle Scholar
  21. 21.
    Wenzl ME, Porte T, Fuchs S, Faschingbauer M, Jurgens C (2004) Delayed union and non-union of the humeral diaphysis—compression plate or internal plate fixation. Injury 35:55–60CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ting-Cheng Chao
    • 1
    • 2
  • Wen-Ying Chou
    • 3
  • Jui-Chang Chung
    • 2
  • Chien-Jen Hsu
    • 1
    • 4
  1. 1.Orthopaedic DepartmentKaohsiung Veterans General HospitalKaohsiung CityTaiwan
  2. 2.Orthopaedic SectionGuo-Ren HospitalPingtungTaiwan
  3. 3.Department of AnesthesiaChang-Gung Memorial Hospital-KaohsiungKaohsiungTaiwan
  4. 4.Department of Physical TherapyFooyin UniversityKaohsiungTaiwan

Personalised recommendations