Journal of Trauma & Treatment

Elastic Stable Intramedullary Nailing for Closed Diaphyseal Fractures of Humerus in Adults. A Case Series of 28 Patients

Abstract

Bahaa A Kornah, Abdel-Aleem Soltan and Mohamed A Abdel-AAl

Aim of study: To demonstrate clinical and radiological effectiveness of intramedullary fixation of closed diaphyseal humeral fractures in adults using the elastic stable intramedullary nail (ESIN).
Patients and methods: Between May 2011 and December 2013, twenty-eight patients (19 males) with closed diaphyseal humeral fractures treated with closed reduction and percutaneous fixation with 2 elastic stable nails. Age from 18 to 56 years (mean, 29 years). Patients with open or pathological fractures, those less than 18 years and medically unfit patients were excluded. Causative injury was pedestrian vehicular accident in 15, fall from height 9 and sport-related activity 4 patients. The time of surgical intervention varied from 24 to 72 hours post-injury.
Results: Patients were followed up 12-31 months with an average of 20 months. X-ray films showed that twentysix fractures united completely at a range 14-20 week (mean, 13.1 weeks). Twenty-Six cases healed in good alignment at a median time of 13.1 weeks (range 14–20 weeks). One case developed delayed union where bone marrow injection and longer immobilization till full healing done. One case developed non-union which was treated by bone grafting and plating. There were no intraoperative complications. One patient with preoperative radial nerve injury recovered spontaneously by eight weeks. Patients followed and assessed using Disabilities of the Arm, Shoulder and Hand score (DASH). At last follow-up, the average DASH score was 90.5 (range 60–100). Final clinical evaluation showed 17 cases Excellent, 8 cases Good, 2 cases fair and one case Poor according to previous score.
Conclusion: Elastic stable nail fixation is a good procedure for treating adult humeral shaft fractures in which stabilization is indicated as it provides stable fixation, with minimal soft tissue stripping at the fracture site and allows early mobilization of the extremity.