Intramedullary Nailing Vs Plate Fixation for the Treatment of Humeral Shaft Fractures; which One is Better?

Abstract

Farzad Amouzadeh Omrani, Mohamadsadegh Rezayian, Mahsa Ejlali, Shahram Sayadi, Mojtaba Baroutkoub, Mohammad Mahdi Omidian, Hasan Barati, Seyed Alireza Ebadi, Reza Tavakoli Darestani

Introduction: Humeral shaft fractures are among the most common long bone fractures. Intramedullary nailing (IMN) and Plate fixation are common approaches with diverse outcomes. The aim of the current study is to compare the outcomes of the mentioned modalities in the treatment of Humeral shaft fractures in a twelve-month follow-up study.
Methods: 90 patients with traumatic fractures of the humeral shaft were randomized into two groups: those treated by IMN and those treated by Plate fixation approach. Intraoperative blood loss was evaluated by hemoglobin test before and within three days after the surgery. Incidence of the complications, including delayed union, nonunion, and nerve injury, were evaluated using questionnaires. The functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score and pain score.
Results: Patients in the IMN group showed higher ASES score and better overall shoulder function (P-value<0.05); however, pain score was lower in patients treated with Plate fixation (P-value=0.003). Three patients in nailing group and two in plating group had delayed union. Nonunion occurred in none (%0) of the IMN compared to two (%5) of the DCP group. The union rate was found to be similar in both groups. Postoperative radial nerve injury occurred in 9 patients of the Plate fixation group and 5 patients in the IMN group, including three radial and two brachial plexuses (P-value=0.001).
Conclusion: The current study showed better postoperative function, lower rate of complications, blood loss, and nerve injury in patients treated with IMN; however, it is more preferable to use Plate fixation approach since the incidence of significant complications in patients treated with IMN i. e, brachial plexus injury, iatrogenic fractures, and shoulder pain.