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COMPARISON OF HUMERUS INTRAMEDULLARY NAIL AND DYNAMIC COMPRESSION PLATE FOR THE MANAGEMENT OF DIAPHYSEAL FRACTURES OF HUMERUS. A RANDOMISED PROSPECTIVE STUDY

KING GEORGE MEDICAL UNIVERSITY,LUCKNOW,INDIA

The aim of this study was to compare the results of humerus intramedullary nail(IMN) and dynamic compression plate(DCP) for the management of diaphyseal fractures of humerus.

Material & Methods: 47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion was Grade 1,2a compound fractures Polytrauma Early failure of conservative treatment Unstable fracture. The patient with pathological fracture, Grade 3 open fracture, refracture, old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach.

Results: The outcome was assessed in terms of functional outcome and the incidence of complications. Functional outcome was assessed using the Americans Shoulder and Elbow Surgeons Score (ASES).On comparing the results, there was no significant difference in ASES score between the two groups. The rate of complications was found to be higher in patients treated with IMN(p<.05). The complications that were encountered with IMN were non union, shortening of the arm,impingement of the shoulder, implant failure. The rate of secondary surgery was also found to be significantly higher with IMN(p<.05)

Conclusion: There is sufficient evidence to suggest that DCP still remains to be the operative treatment of choice for diaphyseal fractures of humerus as use of IMN is associated with long learning curve, technical difficulties and higher complication rate. IMN may be indicated in specific situations like segmental fractures,pathological fratures though this study did not aim to look into that aspect.

The abstracts were prepared by Cormac Kelly. Correspondence should be addressed to The Secretary, British Elbow and Shoulder Society, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE