Locked nailing of humeral fractures

Expandable nail system for osteoporotic humeral shaft fractures: preliminary results

BACKGROUND

Conventional nails rely on interlocking screws for axial and rotational stability. Such screws have poor fixation in patients with poor bone quality (osteopenia). The Fixion nail does not depend on interlocking screws-axial and rotational stability is instead achieved by nail expansion. Therefore, this nail may be better suited for patients with poor bone quality who require humeral stabilization.

METHODS

The system was used to manage 25 unstable humerus shaft fractures in osteoporotic bone. An antegrade approach was used in 18 patients and a retrograde approach was used in 7 patients.

RESULTS

There were no intra- or postoperative complications. Postoperatively, all fractures were stable and had healed by week 16. The mean operative time was 35 +/- 10 minutes (+/- SD) including 1.5 +/- 0.5 minutes of fluoroscopy time.

CONCLUSION

The results of this study show that use of this nailing system is associated with minimal complications, predictable fracture healing, and excellent functional outcomes in a cohort of elderly patients with poor bone quality and humeral shaft fractures requiring stabilization. Further confirmation by larger prospective trials is necessary.

The rationales of interlocking nailing of the femur, tibia, and humerus

Interlocking nailing has been increasingly used to treat acute and chronic afflictions of long bones. Although the interlocking construct is similar, regardless of the anatomic area of application, the results and complications of this type of fixation in the femur, tibia, and humerus differ. This review compares the anatomy, biologic response to injury, and functional expectations of these 3 distinct long bones with respect to interlocking nailing. Final results seem related more closely to the bony anatomy and soft tissue injury than to any inherent success of interlocking techniques.