Complications of intramedullary nailing for fractures of the humeral shaft: A review

Objectives: The purpose of the present review is to document the complicati ons associated with the use of locking humeral nails and to discuss the pre vention and management of these complications. Data Sources: Clinical and research experience supported by a Medline revie w of the English-language literature from 1985 to 1998. Study Selection: The majority of (clinical) information available was conta ined in retrospective reviews; only three prospective or randomized studies were identified (all in abstract form). Anatomical research regarding lock ing humeral nailing was also identified and included. Data Extraction: Because there were so few prospective studies available, a formal meta-analysis of data was not performed. This review focuses on a d escriptive assessment of available information on specific complication-rel ated topics. Conclusions: The attractive theoretical advantages of locking humeral nails have not been borne out in clinical studies. Complications such as shoulde r pain, delayed union or nonunion, fracture about the implant, iatrogenic f racture comminution, and the difficulty in the reconstruction of failures h ave diminished their usefulness. The precise role of locking nails in the t reatment of humeral shaft fractures has yet to be defined. At present, open reduction and compression plating remain the treatment of choice for humer al shaft fractures that require operative intervention.