Treatment of numeral shaft fractures with numeral locked nail and comparison with plate fixation

Objective: To report the experience of a newly devised humeral locked nail in treating acute humeral shaft fractures and to compare its effectiveness with that of plate fixation. Design and Methods: Data were collected on 48 acute humeral shaft fractures in 48 consecutive patients treated with humeral locked nails and compared with retrospective data on 25 fractures in 25 other patients treated with dynamic compression plates. The operation time, amount of blood transfusion, time to union, complications, and functional recovery were recorded and compared. The average follow-up time was 20.5 months for the nail group and 33.3 months for the plate group. Student's t test and Fisher's Exact Test were used for statistical analyses. Results: Locked nailing had significantly shorter operation. time and less blood transfusion than did plate fixation, 68 versus 93 minutes and 0 versus 102 mL, respectively. Eventual union. was achieved among all in the nail group and among all but one in the plate group. Union rate and time to union were not significantly different. In the plate group, three fractures had complications: one with implant loosening and nonunion, one with deep infection, and one with postoperative radial nerve palsy; the nail group had no complications. The difference in complication rates was statistically significant. In the nail group, one varus malunion and one intraoperative comminution occurred, without adverse consequences. Functional recovery was essentially the same in both groups for uncomplicated fractures. Conclusions: Humeral locked nailing offered a less invasive surgical technique and more favorable treatment results than did plate fixation, Correct nailing direction, precise surgical techniques, less bulky hardware, and stable transfixing screws are the keys to a successful treatment, Further prospective, randomized comparative study is warranted.