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More complications seen with IM nailing vs. plating for humeral shaft fractures
Denies E. Acta Orthop Belg.2010;76(6):735-742.
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A study from Belgian researchers supports the use of plating rather than intramedullary nailing for treating patients with midshaft humeral fractures.
The researchers examined the results of 91 patients who had humeral fractures that were treated at a single center using either plate and screw fixation or intramedullary (IM) nailing.
The study revealed no significant differences between the groups regarding the rates of fracture union, reoperation, postoperative radial nerve palsies and problems with osteosynthesis material. A comparison of the groups showed a significantly greater number of patients treated with IM nailing reported pain and/or hindered function in the shoulder or elbow, according to the study abstract. In addition, the researchers found more postoperative complications in the IM nailing group.
“Based on these findings, we suggest that plating of humeral shaft fractures should be considered as the primary treatment for all surgical indications, except for some open fractures requiring temporary external fixation, pathological fractures, humeral shaft fractures in morbidly obese and osteopenic patients, and large segmental fractures of the humerus,” the authors wrote.
These authors report their results in 91 patients treated surgically for an unstable humeral shaft fracture. Specific indications and implant selection rationale is not provided. Although this retrospective review of humeral shaft fractures treated operatively over an eight-year period has some flaws in its methodology, it does provide the reader with several key points.
First, it reaffirms the previously reported fact that operative fixation of these injuries is, in and of itself, a risk factor for delay in healing. The primary union rates of 70% overall in this study falls below the 90% union rate seen with nonoperative care. Secondly, as with the majority of fractures, the choice of implant rarely makes a difference in rates of healing or functional outcome. Each implant is associated with its own set of unique intricacies and complications. Surgeon preference and comfort with a particular implant usually is what relates to factors beyond healing.
The majority of patient outcomes following surgery are related to the initial injury — energy imparted, associated soft tissue condition and articular involvement — as well as, patient factors beyond that of implant selection.
Humeral shaft fractures treated surgically with either an IM nail or a plate and screw construct may be successful if the procedure is indicated properly and performed technically well.
– Kenneth A. Egol, MD
Professor & Vice Chairman
New York University Hospital for Joint Diseases
Department of Orthopaedic Surgery
New York, NY
Disclosure: Egol has no relevant financial disclosures.