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THE MANAGEMENT OF HUMERAL PATHOLOGICAL FRACTURES USING THE FIXION INTRAMEDULLARY NAIL SYSTEM – AN EXPANDABLE SELF LOCKING NAIL

Orthopedic Surgery B, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Disc-O-Tech Medical Technologies, 3 Hasdnaot Street, Herzeliya Israel 46728

Purpose of the Study: To determine the efficacy of using the Fixion Intramedullary Nail System – an inflatable, unreamed, self locking nail in humeral pathologic fracture stabilization. To our knowledge no clinical reports regarding this subject have been published.

Patients and Methods: The medical record and radiographs, of 14 patients treated with the "Fixion" Nail, since October 1999, for pathological or impending humeral fractures, were reviewed. Patients included 6 male and 8 female with mean age of 58.8 years (35–83). Skeletal survey or routine radiograms made diagnosis. Patients harboring tumors were evaluated with isotope bone scan. Loss of approximately 33% of the bone substance was the criteria for nailing procedure consideration. Nine acute pathological fractures and 5 impending fractures were treated. The fracture’s site distribution per distal, medial and proximal humeral shaft were as following: 1, 11, 2, accordingly. Nine patients were operated on via antegrade and 5 via retrograde.

All surgeries were minimally invasive using a single 2–4 cm skin incision.

Results: Excellent humeral anatomical reduction and stabilization were achieved in all patients. Reaming was needed in 4 patients (28.5%). No interlocking screws were used. Significant relief of pain and regained functionality were demonstrated. Average surgical time was 32.7 minutes (20–55). Mean X-Ray radiation time was 4.07 minutes (0.5–6.15). No wound dehisces or other complications were reported.

Conclusion: The unreamed in most of the cases, no interlocking screws, minimal invasiveness and high stabilization capacities in addition to perfect torsion resistance confer to this nail the ideal qualities to be used with excellent results in pathological fractures. Oncological patients that might be immunosuppressive due to different administered therapies could benefit from reduced postoperative infection rate because of minimizing entry point for infection.

The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.