Management Of Comminuted Fracture Of Shaft Of Humerus By Ante-Grade Closed Interlock Nailing
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2016, Vol 2, Issue 2
Abstract
Background:- Open reduction and internal fixation (ORIF) with plates and intramedullary nailing are both advocated for treating comminuted humerusfractures.AO Group recommended anatomical reduction and stable internal fixation with plates osteo-synthesisfor these fractures .However, plating has following dis-advantages, as compared to closed intramedullary nailing by ante-grade method mainly -Extensive soft tissuedissection,Periostealstripping,Loss of fracturehematoma,Significant blood loss, Dissection of radial nerve in middle third fracture, which may endanger the nerve, at the time of surgery or at the time of plate removal after fractureunion,Risk of infection andnon-union, Less secure fixation in osteoporoticbones.Due to above mentioned reasons, this study is taken up to evaluate clinical & radiological outcome of comminuted fractures of shaft of Humerus treated with closed ante-grade interlocked intramedullaryNailing. Materials and Methods:- We prospectively followed a series of 30 consecutive patients with comminuted humeral shaft fracture treated at Govt.Medical College, Latur, Maharashtra, between November 2007 to October 2015 with closed reduction and Ante-grade interlocking intra medullary Humerus nailfixation. Exclusion criteria: - Simple – transverse, oblique, long spiral fractures without comminution. Unstable proximal fracture of shaft humerus. Fracture of distal part ofhumerus with intra articular extension. Fracture of shaft humerus – below 18 years of age. Results and Discussion:- Nail prevents complications found with other osteosynthesis system such as DCP (Dynamic Compression Plate) and unlocked nails. The literature regarding this treatment option has been inconsistent. And has raised some concern based on complicationsnoted. ORIF (Open reduction and internal fixation) with plating has dis-advantages as mentioned previously in Introduction Closed Intramedullary nailing prevents dis-advantages of plating in comminuted fracture Conclusion:- Based on our experience we conclude that closed ante grade intramedullary nailing with interlock nail is safe and reliable method of treating humeral shaft fracture. Essentially all comminuted humerus shaft fractures extending between 5 cm from surgical neck to 2 cm proximal to olecranon fossa can be stabilized by ante-grade closed intramedullary interlock nailing. It is excellent method of managing comminuted and unstable humerus shaft fracture. Long butterfly fragment consolidate early at 4-6 weeks as closed nailing is done.It is best surgical method available to fix comminuted humerus shaft fracture in patients with poly trauma and osteoporosis where reduction in operating time and early rehabilitation are the primary objectives.
Authors and Affiliations
Satish R Gawali, Gajanan M Kathar, Pramod V Niravane, Mahesh Gude
Keywords
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