Reamed Nailing of Humeral Fractures: Long-Term Results in 77 Cases

Abstract

To evaluate the Telescopic Locking Nail® (TLN®) a retrospective analysis of prospectively gathered data was conducted. A total of 77 humeral fractures was included. There were forty-four females and thirty-three males with a mean age of fifty-five years (15-87 years). In fifty-one patients the nail was introduced in the antegrade way, in twenty-six in the retrograde way. We found a primary healing rate of 96 % after a mean of 18.6 weeks (6-61.6 weeks). After a mean follow-up of thirty-five months (2-86 months) forty-seven patients were re-evaluated concerning their shoulder and elbow function. The mean Neer score was 88 points (45-100 points), the mean Morrey score was 97 points (72- 100 points). In the antegrade group (n=31) the mean Neer score was 86 points (45-100 points) and in the retrograde group (n=16) 91 (60-100 points).

The good healing results together with the good functional outcome suggest that the Telescopic Locking Nail is a suitable implant for the treatment of humeral fractures. The lower Neer score in the antegrade group confirms the impact of antegrade nailing on the shoulder function.

Key words

Humerus - Intramedullary - Function - Fracture treatment - Surgery

References

• 1 Bhandari M, Guyatt G. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis.  JOT. 2000;  14 (1) 2-9
• 2 Blum J, Rommens P M, Janzing H, Langendorf H S. Retrograde Nagelung von Humerusschaftfrakturen mit dem UHN - Eine internationale multizentrische Studie.  Unfallchirurg. 1998;  101 342-352
• 3 Chapman J R, Bradford Henley M, Agel J, Benca P J. Randomized prospective study of humeral shaft fractures fixation: intramedullary nails versus plates.  JOT. 2000;  14 (3) 162-166
• 4 Court-Brown C M, Rimmer S, Prakash U, McQueen M M. The epidemology of open long bone fractures.  Injury. 2000;  29 (7) 529-534
• 5 Cox M A, Dolan M, Synnott K, Mc Elwain J P. Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail.  JOT. 2000;  14 349-353
• 6 Crates J, Whittle A P. Antegrade interlocking nailing of acute humeral fractures.  Clin Orthop. 1998;  350 40-50
• 7 Finkemeier C G, Schmidt A H. A prospective randomised study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft.  JOT. 2000;  14 (3) 187-193
• 8 Flinkkilä T, Hyvönnen P, Lakovaara M, Linden T, Ristiniemi J, Hämä läinen M. Intramedullary nailing of humeral shaft fractures - A retrospective study of 126 cases.  Acta Orthop Scand. 1999;  70 (2) 133-136
• 9 Foster R J, Dixon G L, Bach A W, Appleyard R W, Green T M. Internal fixation of fractures and non-unions of the humeral shaft.  J Bone Joint Surg [Am]. 1985;  67 (6) 857-864
• 10 Goessens M L, Van den Wildenberg F A, Eggink G J, Stapert J W. The telescopic locking nail for the humerus.  Osteosynthese International. 1996;  4 270-274
• 11 Habernek H, Orthner E. A locking nail for fractures of the humerus.  J Bone Joint Surg [Br]. 1991;  73 (4) 651-653
• 12 Hall R F, Pankovich A M. Ender nailing of acute fractures of the humerus.  J Bone Joint Surg [Am]. 1987;  69 (4) 558-567
• 13 Heim D, Herkert F. Surgical treatment of humeral shaft fractures - The Basel experience.  J Trauma. 1993;  35 (2) 226-232
• 14 Hems T EJ, Bhullar T P S. Interlocking nailing of humeral shaft fractures - the Oxford experience 1991 to 1994.  Injury. 1996;  27 (7) 485-489
• 15 Ikpeme J O. Intramedullary interlocking nailing for humeral shaft fractures: experiences with the Russell-Taylor Humeral nail.  Injury. 1994;  25 (7) 447-455
• 16 Ingman A M, Waters D A. Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique and clinical results.  J Bone Joint Surg [Br]. 1994;  76 (1) 23-29
• 17 Kelsch G, Deffner P, Ulrich C. Die Humerusverriegelungsnagelung nach Seidel - Klinische Ergebnisse nach 100 Anwendungen.  Unfallchirurg. 1997;  100 111-118
• 18 Linn J L, Sheng-Mou H, Yi-Shiong H, Chao E Y S. Treatment of humeral shaft fractures by retrograde locked nailing.  Clin Orthop. 1997;  342 147-155
• 19 Linn J, Nozomu I, Valdevit H A, Shiong Yi, Sheng Mou H, Chao E Y S. Biomechanical comparison of antegrade nailing and retrograde nailing of humeral shaft fracture.  Clin Orthop. 1998;  351 203-213
• 20 Marty B, Käch K, Friedl H P, Trentz O. Die Marknagelung der Humerusschaftfraktur.  Unfallchirurg. 1994;  97 424-429
• 21 Riemer B L, Butterfield S L, D’Ambrosia R, Kellam J. Seidel intramedullary nailing of humeral diaphyseal fractures: a preliminary report.  Orthopedics. 1991;  14 239-246
• 22 Robinson C M, Bell K M, Court-Brown C M, McQueen M M. Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two year period.  J Bone Joint Surg [Br]. 1992;  74 (4) 558-562
• 23 Rommens P M, Verbruggen J, Broos P L. Retrograde locking of humeral fractures. A review of 39 patients.  J Bone Joint Surg [Br]. 1995;  77 (1) 84-89
• 24 Rommens P M, Verbruggen J, Broos P L. Retrograde Verriegelungsnagelung der Humerusschaftfraktur. Eine klinische Studie.  Unfallchirurg. 1995;  98 (3) 133-138
• 25 Rommens P M, Blum J, Runkel M. Retrograde nailing of humeral fractures.  Clin Orthop. 1998;  350 26-39
• 26 Ruf W, Pauly E. Zur Problematik der Humerusverriegelungsnagelung.  Unfallchirurg. 1993;  96 (6) 323-328
• 27 Seidel H. Humeral locking nail: a preliminary report.  Orthopedics. 1989;  12 (2) 219-226
• 28 Svend-Hansen H, Skettrup M, Ratchke M W. Complications using the Seidel intramedullary nail: outcome in 31 patients.  Acta Orthopedica Belgica. 1998;  64 (3) 291-295
• 29 Tornetta P, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing.  JOT. 2000;  14 (1) 15-19
• 30 Tytherleigh-Strong G, Walls N, McQueen M M. The epidemiology of humeral shaft fractures.  J Bone Joint Surg [Br]. 1998;  80 249-253
• 31 Vander Griend R, Tomasin J. Open reduction and internal fixation of humeral shaft fractures.  J Bone Joint Surg [Am]. 1986;  68 (3) 430-433
• 32 Varley G W. The Seidel locking humeral nail: the Nottingham experience.  Injury. 1995;  26 (3) 155-157
• 33 Ward E F, White J L. Interlocked intramedullary nailing of the humerus.  Orthopedics. 1989;  12 (1) 135-141
• 34 Watanabe R. Intramedulary fixation of complicated fractures of the humeral shaft.  Clin Orthop. 1993;  292 255-263