Humeral nailing tied to early return of upper limb function in humeral diaphyseal fractures

Bogdan Obada et al did the study to evaluate outcomes of the antegrade intramedullary locking nail osteosynthesis for the treatment of the proximal and middle thirds of humeral shaft fractures. The article has been published in "International orthopedics" journal. The authors found that - humeral nailing is associated with early return to function of the upper limb, with very good clinical and functional outcomes of the shoulder and elbow. This method could be considered the best surgical option for the management of proximal middle humeral fractures.

A retrospective study was made on 218 patients diagnosed with humeral diaphysis fractures who undergo surgery with antegrade intramedullary locking nail. The clinical follow-up started two days after surgery and continued at one month, three months, six months and one year. The functional recovery evaluation was performed using visual analogue scale (VAS) score, Rating Scale of American Shoulder and Elbow Surgeons Form (ASES), Mayo Elbow Performance Score System (MEPS) and rate of complications.

The results of the study were:

• Age range between 16 and 89 years and a mean age of 57.13 years (±16.4 standard deviation)

• 96 patients were male (44.04%) and 122 were female (55.96%).

• The most frequent fracture localisation was in the middle third 151 patients (69.27%), followed by the proximal third 67 patients (30.73%).

• Most of the patients sustained injuries after simple fall, including sport accidents, 168 patients (77.06%); the second most common mechanism of injury was road traffic accidents, 31 patients (14.22%), and other types of accidents 19 patients (8.72%).

• According to AO classifications, most of the fractures were classified as type A 131 (60.09%), followed by type B 50 fractures (22.94%) and type C fractures 37 (16.97%).

• The time interval from admission to hospital to surgery was between one and 15 days with a mean of 2.99±2.03 days.

• About 13.76% (30) of patients were diabetics and 50.46% (110) of patients had a heart disease.

• The mean operative time was 114.59±28.2 min with an interval between 70 and 180 min.

• The mean intraoperative blood loss was 138.83±60.61 ml with an interval between 70 and 550 ml.

• The duration of hospitalisation was between two and 13 days with a mean of 6.3±2.11 days.

• The union rate was 99.5%.

• VAS score evaluated at one month, three months and six months indicated a very good overall post-operative experience.

• The ASES and MEPS score were evaluated at six months and one year and showed excellent results•

All the patients (except 1 case) were able to return to their previous jobs within six months.

• The mean intra operative blood loss was 138.83±60.61 ml with an interval between 70 and 550 ml. The duration of hospitalisation was between two and 13 days with a mean of 6.3±2.11 days.

The authors concluded that – "We found that intramedullary locking nail surgery is advantageous in relation with the duration of surgery, the surgical blood loss, early mobilisation, early post-operative pain, duration of hospitalisation, high union rate and low complication rate. Humeral nailing is associated with early return to function of the upper limb, with very good clinical and functional outcomes of the shoulder and elbow." 

Further reading:

Antegrade intramedullary locking nail in the management of proximal and middle thirds of humeral diaphyseal fractures

Bogdan Obada et al

International Orthopaedics (2022) 46:1855–1862

https://doi.org/10.1007/s00264-022-05467-1