RETROGRADE NAILING OF HUMERAL SHAFT FRACTURES

The use of intramedullary nailing in the upper extremity is still cont roversial. Those who have experience with antegrade nailing have eithe r great enthusiasm or strong criticism for the procedure. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrad e nail insertion. The technique of retrograde nail insertion with the unreamed humeral nail is described in detail. In a series of 190 retro grade nailings performed in a prospective multicenter study, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%). All radial nerve palsies recovered spontaneously. Sixty-eight patients were followed up until the fractures healed. There were five (7.4%) b one healing problems. Four of five could be solved with use of the unr eamed humeral nail in a second operative procedure, whereas the fifth bone healing problem required plate osteosynthesis. Function of the sh oulder and elbow joint was excellent in 89.7% and 88.3% of the patient s, respectively. Retrograde humeral nailing is a safe and reliable pro cedure if done properly. It is a valuable stabilization technique for acute and pathologic fractures and for pseudarthrosis. Bone healing pr oblems after unreamed humeral nailing must be analyzed individually, b ut they can be treated with the same implant in combination with cance llous bone grafts, reaming, additional hardware, or intrafragmentary c ompression.