Failure of locked nailing for nonunion of the humoral shaft

Purpose of the study The aim of this work was to assess results after treatment by nailing of no nunion of the humeral shaft. In particular, we focused on consolidation and factors predictive of failure. Material and method A prospective study was conducted in 13 consecutive patients presenting ase ptic nonunion of the humeral diaphysis. There were five cases after orthope dic treatment and eight cases after internal fixation. Two patients had ite rative nonunions. Locked nailing was performed with three successive types of nails: the Seidel nail in four cases, the Russel Taylor nail in seven, a nd the ACE nail in two. Anterograde nailing was used for the first three ca ses and retrograde nailing for the others. All patients were followed regul arly In our department. Last follow-up was one to seven years after nailing . Results Five nonunions (38 %) did not consolidate after locked nailing. Consolidati on was achieved in the other patients after four to 18 months. The anatomic result was good in these patients. Between the success and failure groups, there was no significant difference in age, gender, type of fracture, firs t intention treatment, delay from fracture to nailing, type or diameter of the nail, surgical access or not to the fracture site during nailing, or du ration of complementary fixation. Anterograde nail insertion, used in our f irst three patients in this series, appeared to affect shoulder function. T he retrograde route was used in other patients and did not appear to have a ny impact on the elbow itself or the elbow region. Discussion This clinical study was unable to identify clinical factors explaining fail ures but did provide several arguments suggesting that defective primary st ability of the initial fixation could be incriminated in the failures. Conclusion Centromedullary locked nailing is a simple technique with potential for res olving difficult problems of nonunion. Good functional outcome can be obtai ned when consolidation is achieved. Rather than abandoning this technique, it would be advisable to conduct further research to determine what factors are determinant in its failures.