Abstract
Introduction: Most diaphyseal humeral fractures can be successfully treated with conservative treatment. Nailing is indicated for transverse displaced fractures, pathological or impending fractures, non-unions, fractures with a radial nerve palsy and oblique fractures after failure of conservative treatment. Most surgeons prefer the distal retrograde approach to the humeral canal because of the high incidence of chronic shoulder pain after proximal nailing. However, when using such an approach targeting the holes for proximal static locking is demanding and time consuming. The EXP nail (LIMA LTO) is cannulated and has an original self-looking mechanism that is designed to match the advantages of the retrograde approach. These include rapid proximal locking and reduced radiation exposure.
The proximal locking is achieved by the protrusion of a wire into the medullary bone of the humeral head. Distally the EXP nail has two small wings shaped to sit on the medial and lateral columns of the olecranon fossa.
Cases: We implanted 56 EXP nails in 56 patients. The average surgical time was 40 minutes (min 30, max 110). The average radiation exposure was one minute and 40 seconds (20 seconds for proximal locking). In all cases we obtained fracture union and no patients suffered shoulder pain. In four cases elbow extension was reduced by less than 10. In one case the nail broke but the fracture united.
Conclusions: The EXP humeral nail provides satisfactory stability, it is cannulated and requires minimal radiation exposure.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
