Uncomplicated Diaphyseal Fractures of the Humerus: Plating versus Nailing: Trichy Rajagopal 29th June 2006

Most uncomplicated diaphyseal fractures of the Humerus are treated non-operatively. Successful healing occurs in more than 90% of the cases with non-operative treatment.

In general indications for operative treatment are:

· Unsatisfactory closed reduction

· Open fractures

· Multiple Injuries

· Associated Vascular Injury

· Radial Nerve Palsy after manipulation or worsening Neurological deficit

· Segmental fractures

· Pathological fractures

· Floating Shoulder or elbow

Advantages of Nails:

· Less soft tissue disruption

· Preserves fracture Haematoma

Problems with Nails:

· Shoulder pain and stiffness

· Impingement from prominent hardware

· Risk of further fracture comminution during reaming or nail insertion

Advantages of Plates:

· Anatomical reduction

· Easier during neurovascular exploration and in open fractures

Problems with Plates:

· Greater disruption of soft-tissue envelope

· Risk of infection

· Potential injury to the radial nerve

· Poor fixation in osteoporotic bone

· Possible need for removal of plate at a later date

Evidence:

Author

J. Chapman et al. , University of Washington

Title

Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intra-medullary Nails Versus Plates

Reference

J Orthop. Trauma 2000 Mar-Apr 14(3); 162-66.

Summary

Prospective randomized trial; 84 patients; 38 in the Intra-medullary Nailing (IMN) group- Antegrade locked RT Nail; 46 in the plating (DCP) group. Outcome measures- Fracture healing, complications, shoulder / elbow ROM. Follow-up 13/12 (4-48);

Equal prevalence of complication (22 in IMN and 20 in DCP); Time to union more or less similar (16/52); Six patients in IMN group had reduced shoulder ROM ; Six patients in DCP group had reduced elbow ROM. No difference in outcome

Critique

RCT; Only study with good numbers



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Author

R.G. McCormack et al. Toronto

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