TREATMENT OF HUMERAL SHAFT FRACTURES WITH THE SEIDEL INTRAMEDULLARY NAIL

Background: The use of intramedullary nails for the management of hume ral shaft fractures has been controversial. Recently, the Seidel nail has become available. The purpose of this study was to review our init ial experience with the Seidel nail. Methods: A retrospective clinical and radiographic review of 25 consecutive patients treated with Seide l intramedullary humeral nail was performed. The nail was used for non -union in 10 patients, delayed union in four, acute fracture in eight and pathological fracture in three. Eighteen of the 19 survivors were clinically reviewed at an average of 15 months (range 8-25). Pain, fun ction, satisfaction, shoulder power, range of motion and clinical outc ome were graded using the UCLA shoulder score. Results: Pain was prese nt at the shoulder in four patients and at the fracture site in nine. Average shoulder abduction was 99 degrees and nine patients could not abduct the shoulder past 90 degrees. Sixty-six per cent of patients re viewed were graded as only fair or poor using the UCLA shoulder score. In three patients rotational control was not achieved with the distal locking device at the time of surgery. Complications included non-uni on in 10 patients and three intra-operative fractures. Conclusions: No n-union was more likely to occur if rotational control was not obtaine d, or if the patient had the nail inserted for a previous non-union. U se of the Seidel nail frequently leads to shoulder pain and dysfunctio n. The distal locking device is unreliable and predisposes to non-unio n. We do not recommend the continued use of the Seidel nail.