Complications of intramedullary nailing for fractures of the humeral shaft: A review

Objectives: The purpose of the present review is to document the complications associated with the use of locking humeral nails and to discuss the prevention and management of these complications. Data Sources: Clinical and research experience supported by a Medline review of the English-language literature from 1985 to 1998. Study Selection: The majority of (clinical) information available was contained in retrospective reviews; only three prospective or randomized studies were identified (all in abstract form). Anatomical research regarding locking humeral nailing was also identified and included. Data Extraction: Because there were so few prospective studies available, a formal meta-analysis of data was not performed. This review focuses on a descriptive assessment of available information on specific complication-related topics. Conclusions: The attractive theoretical advantages of locking humeral nails have not been borne out in clinical studies. Complications such as shoulder pain, delayed union or nonunion, fracture about the implant, iatrogenic fracture comminution, and the difficulty in the reconstruction of failures have diminished their usefulness. The precise role of locking nails in the treatment of humeral shaft fractures has yet to be defined. At present, open reduction and compression plating remain the treatment of choice for humeral shaft fractures that require operative intervention.