INTRAMEDULLARY NAILING OF HUMERAL SHAFT F RACTURES

Humeral shaft fractures can be treated either conservatively or operat ively. Plating of the humerus is the established operative method, but recently interest has also been focussed on intramedullary nailing. F ifty-nine cases of humeral fractures treated with intramedullary naili ng (Seidel/Marchetti-Vicenzi/Prevot) from January 1991 to December 199 5 (44 fractures after trauma, 11 pathological fractures, 3 pseudarthro ses, 1 re-fracture). Closed reduction in 55/59 cases. One infection (s oft tissue); 2/48 pseudarthrosis (indication for nailing: pseudarthros is!). No iatrogenic palsy of the radial nerve. Functional postoperativ e treatment in all 44 cases of humeral fractures after adequate trauma . One poor functional result: periarticular ossification after retrogr ade nailing, possibly connected with longterm respiratory treatment af ter trauma. Treatment of humeral shaft fractures by intramedullary nai ling is favoured in our clinic (low complication rates, excellent or g ood functional results, limited approaches, small scars). Proximal fra ctures should be treated by the Seidel nail (stable interlocking of th e proximal fragment); very distal fractures need Prevot nailing (reami ng of condylar canals). All other fractures of the humeral shaft can b e treated by each of the implants used in our clinic. Pathological fra ctures are an excellent indication for intramedullary stabilization. T hese patients benefit from stable fixation without intense surgical tr auma. Pseudarthrosis, according to our limited experience, seems to re quire plating plus bone grafting. Plating is also recommended if revis ion of the radial nerve becomes necessary.