DCR-ESIN technique an effective alternative method for treating adult diaphyseal humeral fractures

Ma et al conducted a study to compare two techniques for the surgical treatment of diaphyseal fractures in the adult humerus: double-crossed retrograde elastic stable intramedullary nailing (DCR-ESIN) and limited-contact dynamic compression plate (LC-DCP). The article has been published in Journal of Orthopaedics and Traumatology.

122 patients with diaphyseal fractures of the humerus who had received DCR-ESIN or LC-DCP were included in the retrospective study. The authors compared union rates, union times, disabilities of the arm, shoulder, and hand (DASH) scores at the postoperative 1-year follow up, and complications between the two groups.

A 4.5-mm LC-DCP was used in the plating group depending on the width of the bone, following appropriate AO principles.

The TENs used in the ESIN technique were inserted using the retrograde method. A small incision (0.5–1 cm) was used to find the bony structures of the medial and lateral epicondyles. The entry points were prepared using an awl or drill. The TENs, which had a diameter of 3.5 mm or 4.5 mm and were pre-bent to ensure maximum curvature, were localized at the fracture site and inserted. The lateral-side TEN was inserted first, followed by the medial-side TEN. The sum of the diameters of the two inserted TENs must be at least 70% of the diameter of the canal. Under C-arm control, a closed reduction was performed when the TENs reached the fracture site. Additional cerclage wire was applied through a miniopen incision without an open fracture site to remove the fracture hematoma when an acceptable reduction could not be achieved. The two TENs were advanced to within 1–2 cm of the proximal metaphysis to allow for good axial rotation control. Finally, the TENs were cut, impacted, and the ends of the TENs were trimmed to 0.5 cm from the bone to prevent skin irritation or ulnar nerve impingement.

The results of the study were:

• Plating management was performed in 63 patients, while DCR-ESIN was performed in 59 patients.

• The union rate was higher in the DCR-ESIN group than in the LC-DCP group (100% vs. 90.5%; p=0.052).

• The union time was shorter in the DCR-ESIN group than in the LC-DCP group (12.0 weeks vs. 14.8 weeks; p< 0.001).

• The intraoperative blood loss and operative time were less in the DCR-ESIN group than in the LC-DCP group (76.4 min vs. 129.5 min; p< 0.001; 60.9 ml vs. 244.8 ml; p< 0.001, respectively).

• The DCR-ESIN had superior results for the rate of overall complications (p=0.006).

• At the 1-year follow-up, the DCR-ESIN group had better DASH scores than the LC-DCP group (p=0.014).

The authors concluded that – "the DCR-ESIN technique, used to treat diaphyseal fractures of the humerus, has shorter operative times, less intra-operative blood loss, shorter union times, and better functional outcomes at 1-year follow-up than the LC-DCP technique. DCR-ESIN may be an alternative method for the surgical treatment of diaphyseal humeral fractures in adults."

Further reading:

Is double-crossed retrograde elastic stable intramedullary nailing an alternative method for the treatment of diaphyseal fractures in the adult humerus?

Hsuan Hsiao Ma et al.

Journal of Orthopaedics and Traumatology (2022) 23:40

https://doi.org/10.1186/s10195-022-00662-7