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International Orthopaedics

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01-10-2020 | Radial Nerve Palsy | Original Paper

Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study

Authors: Yavuz Akalın, İsmail Gökhan Şahin, Nazan Çevik, Burak Olcay Güler, Özgür Avci, Alpaslan Öztürk

Published in: International Orthopaedics | Issue 10/2020

Abstract

Purpose

To compare the radiological and clinical outcomes of interlocking nail (ILN) and locking plate fixation (LCP) for humeral shaft fractures.

Methods

A total of 63 patients with displaced humeral shaft fractures between October 2014 and January 2017 were evaluated prospectively. They were divided randomly into two as LCP fixation (group 1) and interlocking nail (ILN) (group 2). Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles (UCLA) shoulder scores, and Short Form-36 (SF-36) questionnaires, and pain was assessed with visual analogue scale (VAS).

Results

After fracture callus was radiologically observed, DASH, ASES, and UCLA scores as well as SF-36 questionnaires and VAS results were noted to have no significant difference between the two groups (p = 0.109, p = 0.082, p = 0.146, p = 0.322, and p = 0.175, respectively). At the last follow-up (post-operative 24 months), the UCLA score was significantly better in group 1 (p = 0.034), whereas VAS result was significantly worse in group 2 (p = 0.017). DASH, ASES scores, and SF-36 questionnaires had no difference (p = 0.193, p = 0.088, p = 0.289). Other parameters revealed no significant differences. Fracture consolidation was observed at a mean of four months in both groups (3 to 7 months in group 1 and 3 to 8 months in group 2) (p = 0.189). Four patients in group 1 and five patients in group 2 underwent surgery for nonunion (p = 0.725). Post-operative radial nerve palsy was seen in one patient in group 2. Two patients in group 1 with superficial infection were treated with antibiotics, and they recovered.

Conclusions

Regarding our results, the LCP group had significantly better shoulder function than the ILN group, whereas the ILN group had significantly less pain, with similar complication rates. Therefore, both procedures are favourable surgical options for patients with humeral shaft fractures.

Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ (2012) Management of humeral shaft fractures. J Am Acad Orthop Surg 20:11CrossRef

Tsai C-H, Fong Y-C, Chen Y-H, Hsu C-J, Chang C-H, Hsu H-C (2009) The epidemiology of traumatic humeral shaft fractures in Taiwan. International orthopaedics (SICOT) 33:463–467. https://doi.org/10.1007/s00264-008-0537-8CrossRef

Li Y, Wang C, Wang M, Huang L, Huang Q (2011) Postoperative malrotation of humeral shaft fracture after plating compared with intramedullary nailing. J Shoulder Elb Surg 20:947–954. https://doi.org/10.1016/j.jse.2010.12.016CrossRef

Wali MGR, Baba AN, Latoo IA, Bhat NA, Baba OK, Sharma S (2014) Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail: a prospective, randomised study. Strategies trauma limb reconstr 9:133–140. https://doi.org/10.1007/s11751-014-0204-0CrossRefPubMedPubMedCentral

Westrick E, Hamilton B, Toogood P, Henley B, Firoozabadi R (2017) Humeral shaft fractures: results of operative and non-operative treatment. International orthopaedics (SICOT) 41:385–395. https://doi.org/10.1007/s00264-016-3210-7CrossRef

Ekholm R, Tidermark J, Törnkvist H, Adami J, Ponzer S (2006) Outcome after closed functional treatment of humeral shaft fractures. J Orthop Trauma 20:591–596. https://doi.org/10.1097/01.bot.0000246466.01287.04CrossRefPubMed

Koch PP, Gross DFL, Gerber C (2002) The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elb Surg 11:143–150. https://doi.org/10.1067/mse.2002.121634CrossRef

Toivanen JAK, Nieminen J, Laine H-J, Honkonen SE, Järvinen MJ (2005) Functional treatment of closed humeral shaft fractures. Int Orthop 29:10–13. https://doi.org/10.1007/s00264-004-0612-8CrossRefPubMed

Sahu RL, Ranjan R, Lal A (2015) Fracture union in closed interlocking nail in humeral shaft fractures. Chin Med J 128:1428–1432. https://doi.org/10.4103/0366-6999.157630CrossRefPubMedPubMedCentral

10.

Zheng Y-F, Zhou J-L, Wang X-H, Shan L, Liu Y (2016) Biomechanical study of the fixation strength of anteromedial plating for humeral shaft fractures. Chin Med J 129:1850–1855. https://doi.org/10.4103/0366-6999.186645CrossRefPubMedPubMedCentral

11.

Alhammoud A, Maaz B, Alhaneedi GA, Alnouri M (2019) External fixation for primary and definitive management of open long bone fractures: the Syrian war experience. Int Orthop 43:2661–2670. https://doi.org/10.1007/s00264-019-04314-0CrossRefPubMed

12.

Bisaccia M, Meccariello L, Rinonapoli G, Rollo G, Pellegrino M, Schiavone A, Vicente C, Ferrara P, Filipponi M, Caraffa A (2017) Comparison of plate, nail and external fixation in the management of diaphyseal fractures of the humerus. Med Arch 71:97. https://doi.org/10.5455/medarh.2017.71.97-102CrossRefPubMedPubMedCentral

13.

Updegrove GF, Mourad W, Abboud JA (2018) Humeral shaft fractures. J Shoulder Elb Surg 27:e87–e97. https://doi.org/10.1016/j.jse.2017.10.028CrossRef

14.

Baltov A, Mihail R, Dian E (2014) Complications after interlocking intramedullary nailing of humeral shaft fractures. Injury 45:S9–S15. https://doi.org/10.1016/j.injury.2013.10.044CrossRefPubMed

15.

Ma J, Xing D, Ma X, Gao F, Wei Q, Jia H, Feng R, Yu J, Wang J (2013) Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis. PLoS One 8:e82075. https://doi.org/10.1371/journal.pone.0082075CrossRefPubMedPubMedCentral

16.

Gonçalves FF, Dau L, Grassi CA, Palauro FR, Martins Neto AA, Pereira PCG (2018) Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods. Rev Bras Ortop 53:136–141. https://doi.org/10.1016/j.rboe.2017.03.015CrossRefPubMedPubMedCentral

17.

Klenerman L (1966) Fractures of the shaft of the humerus. J Bone Joint Surg Br 48:105–111CrossRef

18.

Liu G, Zhang Q, Ou S, Zhou L, Fei J, Chen H, Nan G, Gu J (2013) Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures. Int J Surg 11:864–868. https://doi.org/10.1016/j.ijsu.2013.08.002CrossRefPubMed

19.

Yi JW, Lee JS, Cho HJ (2017) Retrograde intramedullary nailing for humerus fracture in a supine position: performing an unfamiliar procedure in a familiar position. Clin Orthop Surg 9:392. https://doi.org/10.4055/cios.2017.9.3.392CrossRefPubMedPubMedCentral

20.

Kurup H, Hossain M, Andrew JG (2011) Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev:CD005959. https://doi.org/10.1002/14651858.CD005959.pub2

21.

Putti AB, Uppin RB, Putti BB (2009) Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong) 17:139–141. https://doi.org/10.1177/230949900901700202CrossRef

22.

Hak DJ, Althausen P, Hazelwood SJ (2010) Locked plate fixation of osteoporotic humeral shaft fractures: are two locking screws per segment enough? J Orthop Trauma 24:207–211. https://doi.org/10.1097/BOT.0b013e3181bdd1daCrossRefPubMed

23.

Fan Y, Li Y-W, Zhang H-B, Liu J-F, Han X-M, Chang X, Weng X-S, Lin J, Zhang B-Z (2015) Management of humeral shaft fractures with intramedullary interlocking nail versus locking compression plate. Orthopedics 38:e825–e829. https://doi.org/10.3928/01477447-20150902-62CrossRefPubMed

24.

Babhulkar S, Babhulkar S, Vasudev A (2017) Recalcitrant aseptic atrophic non-union of the shaft of the humerus after failure of surgical treatment: management by excision of non-union, bone grafting and stabilization by LCP in different modes. Injury 48:S33–S43. https://doi.org/10.1016/S0020-1383(17)30492-8CrossRefPubMed

25.

Seo J-B, Heo K, Yang J-H, Yoo J-S (2019) Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: comparison with single 4.5-mm locking compression plate fixation. J Orthop Surg (Hong Kong) 27:230949901983960. https://doi.org/10.1177/2309499019839608CrossRef

26.

Wang X, Chen Z, Shao Y, Xia Q, Ma Y, Fu D (2013) A meta-analysis of plate fixation versus intramedullary nailing for humeral shaft fractures. J Orthop Sci 18:388–397. https://doi.org/10.1007/s00776-013-0355-8CrossRefPubMed

27.

Shin S-J, Sohn H-S, Do N-H (2012) Minimally invasive plate osteosynthesis of humeral shaft fractures: a technique to aid fracture reduction and minimize complications. J Orthop Trauma 26:6CrossRef

28.

Caforio M, Maniscalco P, Colombo M, Calori GM (2016) Long endomedullary nail in proximal third humeral shaft fractures. Injury 47:S64–S70. https://doi.org/10.1016/j.injury.2016.07.037CrossRefPubMed

29.

Gallucci GL, Boretto JG, Alfie VA, Donndorff A, De Carli P (2015) Posterior minimally invasive plate osteosynthesis (MIPO) of distal third humeral shaft fractures with segmental isolation of the radial nerve. Chirurgie de la Main 34:221–226. https://doi.org/10.1016/j.main.2015.06.007CrossRefPubMed

30.

Chapman JR, Henley MB, Agel J, Benca PJ (2000) Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 14:162–166. https://doi.org/10.1097/00005131-200003000-00002CrossRefPubMed

31.

Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Möller M (2016) Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish fracture register. BMC Musculoskelet Disord 17. https://doi.org/10.1186/s12891-016-1009-8

32.

Watson JT, Sanders RW (2017) Controlled compression nailing for at risk humeral shaft fractures: journal of orthopaedic trauma 31:S25–S28. https://doi.org/10.1097/BOT.0000000000000846CrossRefPubMedPubMedCentral

33.

Putnam JG, Nowak L, Sanders D, MacNevin M, Lawendy A-R, Jones C, McKee M, Schemitsch E (2019) Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures. Injury 50:1460–1463. https://doi.org/10.1016/j.injury.2019.06.014CrossRefPubMed

34.

Schwab TR, Stillhard PF, Schibli S, Furrer M, Sommer C (2018) Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome. Eur J Trauma Emerg Surg 44:235–243. https://doi.org/10.1007/s00068-017-0775-9CrossRefPubMed

35.

Zhao Y, Wang J, Yao W, Cai Q, Wang Y, Yuan W, Gao S (2017) Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials. Osteoporos Int 28:3229–3237. https://doi.org/10.1007/s00198-017-4174-1CrossRefPubMed

36.

Zhao J-G, Wang J, Wang C, Kan S-L (2015) Intramedullary nail versus plate fixation for humeral shaft fractures: a systematic review of overlapping meta-analyses. Medicine 94:e599. https://doi.org/10.1097/MD.0000000000000599CrossRefPubMedPubMedCentral

Title: Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study
Authors: Yavuz Akalın
İsmail Gökhan Şahin
Nazan Çevik
Burak Olcay Güler
Özgür Avci
Alpaslan Öztürk
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Radial Nerve Palsy
Humeral Shaft Fracture
Published in: International Orthopaedics / Issue 10/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04696-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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