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Nailing, plating may be reasonable options for treatment of humeral shaft fractures
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WAIKOLOA, Hawaii — When performing surgical treatment of humeral shaft fractures, surgeons may experience positive outcomes with nailing or plating, according to a presenter at Orthopedics Today Hawaii.
In his presentation, William M. Ricci, MD, noted the advantages of plating include high union rates, low complication rates, low rates of shoulder dysfunction and reoperation, and identification of the radial nerve with the posterior approach. Nailing also has advantages of limited dissection, being a closed technique, ease of insertion and it is a load-sharing device, according to Ricci.
However, Ricci noted plating has the disadvantages of a lot of soft tissue dissection and a risk of iatrogenic injury to the radial nerve, while nailing may lead to shoulder dysfunction and the potential for nonunion. He added that surgeons need to use interlocks when nailing and need to be careful of multiple nerves in multiple portions of the procedure.
“You have to use interlocks. If it is not interlocked, you are going to have a higher rate of nonunion with a nail,” Ricci said.
According to Ricci, intramedullary nails are indicated for pathologic fractures.
“As far as a fracture pattern, I do not think there is any specific fracture pattern that is more or less amenable,” he said. “I think the transverse ones are probably the most ideal, especially if you can compress them.”
Surgeons can also use nails with spiral fractures and comminuted fractures, Ricci said. He added one technique to use when nailing a humeral fracture is to expose the cuff, split the cuff and repair the cuff.
For plating, Ricci noted that the posterior approach is most common.
“If you have a more ... proximal shaft fracture, then you are going to [have] your deltoid pec extending into an anterior lateral approach, but posterior approach is probably the most common,” Ricci said. “You can cover almost the entirety of the humerus [with] the posterior approach.” – by Casey Tingle
Reference:
Ricci WM. Fractures of the humeral shaft. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosure: Ricci reports he has ownership interest in Cabel Fix LLC, CrookedFoot Medical LLC, McGinley Orthopaedic Innovations LLC and Primo MC LLC; received royalties from MicroPort, Smith & Nephew and Wolters-Kluwer; has potential royalties from SMV Orthopaedics; is a consultant for Smith & Nephew; receives institutional support from AO North America; and board memberships with the Orthopaedic Trauma Association, Journal of Orthopaedic Trauma and Hospital for Special Surgery.