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Retrograde Halder humeral nails show benefits for distal third fracture treatment
None of the 45 patients treated with the nails during a 16-year period had an iatrogenic nerve palsy.
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Treatment of distal third humeral shaft fractures with a retrograde nail that allows for use in any part of the humerus yields excellent results, according to a study presented earlier this year.
“[The] Halder nail (Corin Group; Cirencester, United Kingdom) is an excellent implant for humeral fractures at any level, [though] initially this nail was designed for proximal fractures,” Hinesh Bhatt, FRCS (Tr&Orth), of Huddersfield Royal Infirmary in England, said during a presentation. “But we have found that because of this unique entry point, this nail can be used even for distal fractures. [This is a] better option, certainly, than plating, especially when there is severe comminution and where the bone quality is not that good [and] where fixation could be difficult. The risk of iatrogenic nerve palsy is much lower compared to locked plating.”
Different from conventional nails
Bhatt noted that the retrograde Halder humeral nail differs from a conventional retrograde nail.
“[With] conventional retrograde nail, the entry point is 2.5 cm above the olecranon fossa, whereas this nail, [you have] the option of passing it right from the roof of the olecranon fossa,” Bhatt said.
Bhatt and colleagues treated 45 cases of distal third fractures of the humerus with the retrograde nail between 1994 and 2010. The patients had a mean age of 30.4 years, and there were 26 women and 19 men in the study. Surgeons used a triceps-split posterior approach for all patients and fixed the fractures distally with a locking screw and proximally with a trio wire and locking screw. According to the study abstract, the patients underwent active mobilization at 2 weeks. The patients were followed up at 2 weeks and then every 6 weeks until they showed clinical and radiologic evidence of union.
Union rates
The investigators found that union occurred at an average of 13.9 weeks, with a range of 9 weeks to 36 weeks. None of the patients had iatrogenic radial nerve palsy or implant failures, Bhatt said that all of the patients had good elbow function and elbow range of movement.
The researchers discovered two cases of nonunion, one of which healed at 9 months following a second surgery. The remaining nonunion case was asymptomatic, according to the study abstract.
One patient had a postoperative infection and required implant removal and seven patients elected to have their nails removed. – by Renee Blisard Buddle
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Disclosure: Bhatt has no relevant financial disclosures.