TERLOCKING NAIL FIXATION FOR HUMERAL SHAFT FRACTURES

Abstract

The accepted trea tm ent of the isol ated l ow-ener!:-'Y humeral shaft ll·:1c ture is functi onal bracing. This m ethod of treatment has yielded very <lu;ptable results (Sa rmiento et al , 1 977).

Il owevcr, the fi·actures of the h umerus tha t are associa ted with hi :•h 0

energy. si gnifican t comminution, unsta ble fracture pattems, or fi·actures th a t

:::-.·bee:: difficu lt t;::, red uce or maintain reduction have all been difficult to

t reat using the closed nonoperati ve functional method (Mast et al , 1 975).

Hum era l sha fi fractures ca used by high eneq:,ry tra um a, howe \'er, fl·eque ntl y require operat i ve fi xation (Brumback et al , 1 986). Indications lor surgicn l treatment of humeral sha ft fractures incl ude open fractures, SL'grnent;rl fractures. bilateral fractures, floating elbow injuries, fractures assm:int ed w i th vascul ar injuries or progressi ve neurologic injuty, and fi·a ctures in pat ients with multi pl e irtiwies (Henley et al, 1 992). The most comm onl y ad vocated operati ve methods of treatm ent n re dyrwrni c com pression pl a t i ng (Dabezies et al, 1 992 ), ant egrade or retrograde fk, iblc nail ing (Henl ey et al , 1 992), and antegrade or retrobrrade locking intram edu ll ary na iling ( lkpeme,1 994 ). Plates require extensi ve soft tissue st r ip ping for application , and comminuted fi·actures often need bone b'rafl ing ( l>;rbezi es et al, 1 992). Fl exibl e nail s lack rotationaJ control , may migrate, and us ually require supplemental bracing (Stem et al , 1 984). The development of l ocked humeral nailing has occurreJ 111 order to

m e rcom e these problems in operati ve treatment (Seidel, 1 989).

Locked intramedullmy nails usually ca n be inserted usmg cl osed ted111iqucs: avoid ing the extensive soft tissue dissection req uired for plat ing ( f{ol lllllt.:ns et a l. 1 995).The interlocking feature of these na il s gi \ es