Deepak P. Kaladagi1 , Kaladagi P.S 2 , K. Ramachandra3 , Shiv Sandeep S.V4 , Gurneet Singh Bakshi5
BACKGROUND: The incidence of humeral fracture has significantly increased during the present years due to the population growth and road traffic, domestic, industrial, automobile accidents & disasters like tsunami, earthquakes, head-on collisions, polytrauma etc. In order to achieve a stable fixation followed by early mobilization, numerous surgical implants have been devised. PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of proximal 2/3rd humeral shaft fractures using an unreamed interlocking intramedullary nail. INTRODUCTION: In 40 skeletally matured patients with fracture shaft of humerus admitted in our hospital, we used unreamed antegrade interlocking nails. MATERIAL: We carried out a prospective analysis of 40 patients randomly selected between 2001 to 2014 who were operated at JNMC Belgaum, MMC Mysore & Navodaya Medical College, Raichur. All cases were either RTAs, Domestic, Industrial, automobile accidents & also other modes of injury. METHOD: Routine investigations with pre-anaesthetic check-up & good quality X-rays of both sides of humerus was taken. Time of surgery ranged from 5-10 days from the time of admission. Only upper 1/3rd & middle 1/3rd humeral shaft fractures were included in the study. In all the cases antegrade locked unreamed humeral nails were inserted under C-arm. Patient was placed in supine position & the shoulder was kept elevated by placing a sandbag under the scapula. In all patients incision taken from tip of acromion to 3cm over deltoid longitudinally. Postoperatively sling applied with wrist & shoulder movements started after 24 hours. All the patients ranged between the age of 21-50 years. RESULTS: Total 40 patients were operated. Maximum fracture site were in the middle third- 76%, 14% upper 1/3rd. All 40 patients achieved union. The average time of union was 8-10 weeks. All patients regained full range of movements except in few cases, where there was shoulder impingement at the site of insertion of nail, superficial infections, delayed union, neuropraxia. DISCUSSION: Bell et al (1985) reported RTA as cause in 73 % and Balfour et al (1982) reported 21-30 years as the age group of patients having the maximum number of humeral shaft fractures. 1 Naimen et al (1987) reported average time of union to be 11 weeks. 2 So we feel fracture union is quick in interlocking nail. We have got union rate of 100 % whereas Bell reported union rate of 94 % with DCP. 3 We conclude that unreamed intramedullary interlocking nail is one of the best methods of treatment of humeral shaft # & can be used in the upper 1/3rd & middle 1/3rd pathological # of shaft of humerus. The procedure avoids osteonecrosis due to reaming. Unreamed humeral nailing of the pathological humeral shaft fractures provides immediate stability and pain relief, minimum morbidity and early return of function to the extremity.
