Comparison of results between dynamic compression plate and interlocking nail for the management of fracture shaft of humerus

Abstract

Surgical fixation of a fracture of the shaft of humerus can be achieved by Plating or Nailing. Plating provides satisfactory result, but requires extensive dissection, and meticulous radial nerve protection. The theoretical advantage of intramedullary nailing included less invasive surgery, an undisturbed fracture hematoma and use of a load sharing device support. This study compares the two more commonly used interventions: locking/dynamic compression plating and locked intramedullary nailing. Patients admitted were randomly assigned to either ILN group (Group A) or DCP group (Group B). In group a, internal fixation with interlocking nail done. In the plating group (Group B), fixation was done with 4.5 mm dynamic/locking compression plates using either anterolateral or posterior approach. All the cases were regularly followed up. Functional outcome is determined on the basis of disability arm shoulder and hand score (DASH). Union was present in 18 (90%) patients in the ILN group whereas in the DCP group, union was present in the 17 (85%) patients. Average union time is 7.83 with standard deviation of 1.54 weeks in the ILN group and 8.64 with standard deviation of 1.96 weeks in the DCP group. DASH score for the ILN group is 33.74 with standard deviation of 14.18 whereas it is 27.66 with standard deviation of 10.32 in the DCP group. The DASH score of the two groups is statistically insignificant (p>.05). Both the modalities of treatment are good as far as union of the fracture is concerned, but considering the rate of complications we concluded that dynamic compression plating offers better result than interlocking nailing with respect to pain and function of the shoulder joint.