Die Marknagelung von Humerusfrakturen mit gekürzten Federnägeln nach Simon-Weidner/Ender

Summary

Goal of Surgery

Healing of fracture in normal axis line.

Rehabilitation to normal functions.

Indications

Fractures between the 2/6 and 4/6 of the humeral shaft (esp. transverse and comminuted fractures, AO-classification A3, C1-3).

Contraindications

Fractures located in the segment 1/6 for descendent nailing and in the segments 5/6 and 6/6 for ascendent nailing.

Primary radial nerve palsy.

Vascular injury at the fracture site.

Grade III open humerus fractures.

Surgical Technique

Fixation of fracture with specially designed nails.

Introduction into the medullary space from dorsal through a cortical window above the olecranon fossa.

Protruding nail ends are locked with an interlocking screw.

Postoperative Management

Velpeau dressing for 2 to 4 days.

Active and passive exercises. Resuming off normal activities except lifting and carrying of weights > 5 kg. In case of osteoporosis apply orthodesis for 6 to 8 weeks. Radiologic control after 6 weeks, 6 months and prior to implant removal.

Possible Complications

Perforation of humeral head.

Paresis of radial nerve.

Infections.

Nail migration.

Malunion.

Results

During 4 years 36 patients (average age:65.9 [19 to 88] years), including 6 pathologic fractures were treated with this technique.

28 out of 30 traumatic fractures healed within 8 weeks.

Two revisions were necessary because of technical difficulties. 6-months follow-up showed according to Kwasny score excellent and good results in 27 patients, satisfactory results in 2 and poor in 1 patient. The 6 patients with pathologic fractures died during the follow-up time. However, they were painfree and with full mobility during this time.