The effectiveness of intramedullary nailing in humeral diaphysis fractures and non-unions

Abstract

Purpose:The analysis of treatment results of humeral non-unions with intramedullary nailing (IMN) according to primary treatment is not argued convincingly in literature. Materials and methods: The results of 39 patients who treated with intramedullary nailing for humerus diaphysis fracture or non-union analysed in this study. An antegrade IMN technique was used with an interlocking intramedullary nail (Russell-Taylor type) in all cases. Twenty-six of these patients had primary IMN, seven had revision for failed plating and six had exchange IMN. Results:The non-union rate was 15% in primary IMN, 29% in the revision for failed plating and 83% in exchange IMN groups. The average time to union were found as 14 weeks in the primary IMN and 20 weeks in the revision for failed plating. Even though revision for failed plating had similar healing rate with primary IMN (p>0.05), the healing time significantly increased. (p<0.05) The exchange IMN had the worst results. (p<0.05 against other groups). Conclusion: IMN for humeral shaft fracture may be considered as an effective method of primary treatment. Exchange IMN in the humerus seemed to be a non-effective treatment modality and should be better to be avoided. In contrast IMN for a non-union after failed plating is an effective treatment. The non-unions of humerus shaft should be better to be treated with changing the implant type.