Abstract
Both our own experience with antegrade nailing of the humerus and reports in the literature have made us aware of some of the drawbacks of this technique. Invasion of the intact shoulder is associated with damage to the rotator cuff and possible ectopic calcification, resulting in subacromial impingement. The ‘blind’ percutaneous placement of the top locking screw may endanger the axillary nerve and/or the bicipital tendon.
From 1990 to 2000 we performed 144 retrograde nailings, 41 of which were lost to follow-up. For two years we followed up the remaining 103 patients, 71 men and 32 women, who had sustained 83 closed and 20 compound fractures, 14 of which were caused by gunshots. There were 89 recent fractures and 14 cases of nonunion, nine of them the outcome of non-surgical management. Seidel interlocking nails were used in 92 patients and Russell-Taylor in 11. Reaming was invariably done, first to prevent jamming of the nail and fracture propagation, secondly to create endosteal bone transport (equivalent to bone grafting), and thirdly to contribute to bone morphogenetic protein release.
The results were encouraging. In fresh fractures callus was present after 5 to 8 weeks and in nonunions after 10 to 14 weeks. In 10 patients, iatrogenic periportal uni-cortical fractures occurred. These healed at the same pace as the original fracture and did not affect the functional recovery. There were no vascular complications. One patient developed transient radial nerve paresis, but there was no permanent neurological damage. No sepsis developed in previously uninfected fractures. Shoulder and elbow function remained normal.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
