Middle third humerus fractures in adults: Intramedullary nails vs. locking compression plates

Abstract

Background: 2 to 3% of all traumatic fractures in adults encountered by orthopaedic surgeons are humerus fractures. Operative management for these fractures has now gained popularity among surgeons to allow patients an early recovery and return to premorbid conditions. We compared the two commonly used implants for treating humerus shaft fractures, that is, locking compression plates and intramedullary nails in terms of complications associated and range of movements. Materials and methods: 40 patients were allotted into 2 groups, with 20 undergoing treatment with locking compression plates and 20 undergoing intramedullary nailing. The 2 groups were comparable when pre-operative demographics were analysed. Post-operative follow up showed the following results. Results: Axillary nerve injuries were noted in 4 out of the 20 patients in the nailing group and radial nerve palsy was note in 1 patient in the plating group after surgery. 2 cases of superficial wound infection and 1 case of deep wound infection were recorded in the plating group. 1 patient in each group were found to have delayed union. A significantly higher incidence of shoulder stiffness was recorded in the intramedullary nailing group. A significant difference in the DASH score was recorded, in favour of the plating group. This could be attributed to the pain free movements at shoulder joint. A significant difference in the Rodrigues Merchan outcome was seen, in favour of the plating group, with 70% patients having achieved good to excellent outcome, as opposed to 25% in the nailing group. A higher incidence of poor outcomes was seen in the nailing group due to shoulder related complications. Conclusion: We concluded that Open reduction and internal fixation with locking compression plates gave a better outcome to patients when followed up after surgery as compared to closed reduction and internal fixation with interlocking nails, primarily due to the shoulder related complications associated with intramedullary nailing.