Complications of locked nailing in humeral shaft fractures

Background: The purpose of this study was to investigate the complications of humeral locked nailing. Methods: Between 1994 and 2000, 161 humeral shaft fractures (98 acute fractures and 63 delayed unions or nonunions) in 159 patients treated with humeral locked nails were followed up for an average of 25.4 months. There were 89 men and 70 women, with an average age of 53.5 years. Acute fractures included 68 closed, 18 type 1, 8 type 11, 3 type IIIA, and I type RIB open fractures. Thirty-six nonunions had previous operations. In general, acute fractures were treated with closed nailing and nominions were treated with open nailing with bone grafting. Since 1998, interfragmentary wiring has been added in nonunions to compress the fracture. Results: In total, 30 patients had 31 significant complications. Nine of them were persistent nonunions, six from acute fractures and three from nominions. Fracture gap was associated with a significantly higher risk of nonunion. The risk of operative comminution was significantly higher in retrograde nailing, and operative comminution resulted in a significantly higher risk of nonunion. Seven of the nine nonunions underwent revisional nailing and achieved eventual union. Removal of the protruded screws was performed in two cases. Other complications included shoulder impairment, elbow impairment, angular malunion, and post-nailing radial nerve palsy. Conclusion: Many complications of humeral locked nailing can be prevented by improving the implant design or surgical techniques. The patients with persistent nonunion can be reliably treated by revisional nailing and bone grafting.