Management of Humeral Shaft Fracture: A Comparative Study between Interlocking Nail and Dynamic Compression Plating
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 10
Abstract
Background: Humeral shaft fractures are commonly seen by orthopaedic surgeons accounting for about 3% of all fractures. Advancement has been made in both operative and non-operative management. Most humeral shaft fractures can be managed non-operatively with good results. Methods: 29 cases with fracture of shaft of humerus were treated operatively. Out of these, 15 cases (Group- A) undergone internal fixation by humeral interlocking nail and 14 cases (Group -B) undergone internal fixation by dynamic compression plating, with or without bone grafting. Bone grafting were done in 8 cases of Group-A and 5 cases of group-B. Results: All cases, except one from each group not returned to their previous occupation. Both of these cases developed non-union. They were able to do day to day activities but not able to do their occupation.2 cases from group A and one from group B were lost during follow up. Thus the functional result was good in 92.3% (12 out of 13 cases) of cases and poor in 7.7% (1 out of 13 cases) of cases of the either group. 4 cases in group-B (30.8%) managed by dynamic compression plating developed infections later. In this study complications were also observed. Two of them were superficial infections that responded well after giving antibiotics and dressings and later healed better and united. Both cases developed discharging sinuses and subsequently infected union. Later the removal of plate was done and sinus tract was excised. The sinus tract was healed with unsightly scar marks. Only one patient (7.7%) of group-A developed deep infection and subsequent non-union. 3 cases of group-A (23.1%) developed shortening ranging from 1.5cm to 4cm. All these cases were cases of old non-union with sclerotic bone ends which had to be nibbled and refreshed. Shortening developed in 2 cases (15.4%) of group-B. One non-union were seen in each group. While the one of the screws of dynamic compression (7.7%) went loose, no implant failure seen in interlocking nails. One case (7.7%) of group-A developed axillary nerve injury, which might be attributed to the fact that the incision extended 6-7 cm beyond the acromion process. Only one case in group-B developed 10 degree angulation. Conclusions: Dynamic compression plating is the excellent method of stabilizing transverse diaphyseal fractures of humerus. The compression produced at the fracture site by the plate promoting osteosynthesis. But the technique is not suitable for segmental fractures, pathological fractures, communited fractures, gross osteoporosis, non-union and fractures much proximal or distal to shaft. Introduction of interlocking nailing has largely solved problems faced by the standard dynamic compression plating technique. An advantage of humerus interlocking is that even after developing non union day to day activities could be performed whereas in cases with loosening of screws it was difficult
Authors and Affiliations
Dr Noorul Ameen
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