Early Treatment Outcome of Humeral Shaft Fracture Non-Union in Adults: Comparative Study of Plating versus Interlocking Nailing

Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3rd of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.

Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing

Purpose:In the surgical treatment of paediatric forearm fractures,plate-screw and titanium elastic nails are used.During the transformation of ligamento-osseous structures from adolescence form into adult form,more stable fixation is required.The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures.Methods:A retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture.The included patients were in the adolescent age group(12-17 years),did not meet conservative follow-up criteria and had unstable fractures(>10 angulation and<50%cortex continuity after plaster casting).Patients were excluded from the study if they were aged>18 years or<12 years,had Gustilo-Anderson type 2/3 open fractures,multitrauma,history of physeal injuries or could not be contacted during follow-up.Patients'age,gender,body mass index,affected side,and the pronation and supination values during follow-up were noted.Functional evaluation of the patients was performed with disabilities of the arm,shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria.The time to union,infection during follow-up,re-fracture and vascular nerve damage were also examined.Data were analyzed using SPSS 22 Windows package program software.Results:The patients comprised 30 males and 6 females(ratio,5:1)with a mean age of(14.7±2.1)years(range,12-18 years).According to the Price criteria,the results of 33 patients were excellent,3 were good and there were no moderate or poor cases.The mean disabilities of the arm,shoulder and hand score was 11.2±6.1(range,4-28).The mean time to union was(8.7±2.2)weeks(range,6-14 weeks),while patients aged>15 years had prolonged time to union([11.1±1.8]weeks).There were no non-unions,re-fractures or infections.No complications were observed during implant removal.None of the patients had sensorial radial nerve injury or tendon damage.Conclusion:The locked intramedullary nailing technique,which is minimally invasive and provides biological fixation,was found to be successful and safe in the treatment of adolescent forearm fractures.