RETROGRADE NAILING OF HUMERAL SHAFT FRACTURES WITH THE UHN - AN INTERNATIONAL MULTICENTER SURVEY

Combined with the new unreamed humeral nail (UHN) (Synthes(R)), the re trograde approach to the endomedullary canal of the humeral shaft prom ises careful reduction and fixation of humeral shaft fractures. This p rospective multicenter study reports and analyses 102 retrograde naili ngs with the UHN and their operative procedures. Seven patients with p athological fractures have died meanwhile, but 75 patients could be fo llowed up until bone healing. Seventy-three fresh humeral shaft fractu res, 12 pseudarthrosis, 3 refractures and 14 pathological fractures ha ve been treated with the UHN. In 98 cases (96.1%) the surgeon estimate d fracture stability well enough to initiate immediate postoperative e lbow and shoulder mobilization. The difficulties involved with free-ha nd interlocking proximally at the nail tip in 5.9%, fissure or avulsio n at the insertion point in 3.9% and radial nerve palsy also in 3.9% o f the cases were the most important intraoperative complications. In a ll 75 patients followed up, bone healing occurred, but five fractures (6.7%) needed more than 8 months connected with a second operative pro cedure. In one case spongious bone transplantion and new locking bolts had been performed. In three cases a special compression device has b een used, whereas in one case also a new nail and in the second spongi ous bone transplantion had been added. In the fifth case plate osteosy nthesis had been performed. At the end of treatment 89.4% of the patie nts had excellent shoulder function and 88.0% excellent elbow function . Once the indication for surgery is established, the UHN can be consi dered a reliable and safe implant for stabilizing humeral shaft fractu res.