- Volume 18 Issue 2
DOI QR Code
Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures
Yang, Hee Seok;Kim, Jeong Woo;Kang, Hong Je;Park, Jung Hyun;Lee, Yong Chan;Kim, Kwang Mee
- Received : 2014.10.28
- Accepted : 2015.06.01
- Published : 2015.06.30
Background: Our aim was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on a Polarus intramedullary nail for the internal fixation of humeral shaft fractures. Methods: From January 2008 to March 2014, we enrolled 26 patients with humeral shaft fractures who were operated on using intramedullary nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the Polarus nail: in group 1, a single interlocking distal screw was used in 12 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. To compare the nonunion and shoulder function, we assessed each patient's modified American Shoulder and Elbow Surgerns (ASES) score. Results: We found that 10 of 12 fractures achieved union in group 1, and 13 of 14 fractures, in group 2. We did not find a meaningful difference in the time to bone union between the two groups. The percentage of recovery of displaced fracture fragments until union was 66.9% for group 1 and 59.41% for group 2. At the final follow-up, we found that the scores for shoulder joint modified ASES was 78.7 for group 1 and 80.7 for group 2. Conclusions: Our results show that if locked appropriately, even a single screw on a Polarus nail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.
Humeral fractures;Intramedullary nailing;Bone screws
- Ekholm R, Adami J, Tidermark J, Hansson K, Tornkvist H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br. 2006;88(11):1469-73.
- Sarmiento A, Waddell JP, Latta LL. Diaphyseal humeral fractures: treatment options. Instr Course Lect. 2002;51:257-69.
- Nam TS, Choi JW, Kim JH, Kim SY, Kim JJ, Chun JM. Nonunion of the humerus shaft. J Korean Fract Soc. 2005;18(3):294-8. https://doi.org/10.12671/jkfs.2005.18.3.294
- Lee HJ, Oh CW. Operative treatment of humerus shaft fracture: conventional open plating or minimally invasive plate osteosynthesis. J Korean Fract Soc. 2012;25(2):155-62. https://doi.org/10.12671/jkfs.2012.25.2.155
- Meekers FS, Broos PL. Operative treatment of humeral shaft fractures. The Leuven experience. Acta Orthop Belg. 2002;68(5):462-70.
- Chen F, Wang Z, Bhattacharyya T. Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study. J Orthop Trauma. 2013;27(2):68-72. https://doi.org/10.1097/BOT.0b013e31824a3e66
- Chen AL, Joseph TN, Wolinksy PR, et al. Fixation stability of comminuted humeral shaft fractures: locked intramedullary nailing versus plate fixation. J Trauma. 2002;53(4):733-7. https://doi.org/10.1097/00005373-200210000-00019
- Levin PE, Schoen RW Jr, Browner BD. Radiation exposure to the surgeon during closed interlocking intramedullary nailing. J Bone Joint Surg Am. 1987;69(5):761-6. https://doi.org/10.2106/00004623-198769050-00019
- Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury. 2005;36(1):75-80. https://doi.org/10.1016/j.injury.2004.03.023
- Riemer BL, Butterfield SL, D'Ambrosia R, Kellam J. Seidel intramedullary nailing of humeral diaphyseal fractures: a preliminary report. Orthopedics. 1991;14(3):239-46.
- Spiguel AR, Steffner RJ. Humeral shaft fractures. Curr Rev Musculoskelet Med. 2012;5(3):177-83. https://doi.org/10.1007/s12178-012-9125-z
- Garnavos C, Lasanianos N. Intramedullary nailing of combined/extended fractures of the humeral head and shaft. J Orthop Trauma. 2010;24(4):199-206. https://doi.org/10.1097/BOT.0b013e3181b2b74d
- Lin J, Hou SM. Locked nailing of severely comminuted or segmental humeral fractures. Clin Orthop Relat Res. 2003;(406):195-204.
- Brumback RJ, Bosse MJ, Poka A, Burgess AR. Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg Am. 1986;68(7):960-70. https://doi.org/10.2106/00004623-198668070-00002
- Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma. 1998;44(5):859-64. https://doi.org/10.1097/00005373-199805000-00019
- Hall RF Jr. Closed intramedullary fixation of humeral shaft fractures. Instr Course Lect. 1987;36:349-58.
- Park JY, Oh JH, Kho DH, Jung JK. Intramedullary nail on the humeral fracture. J Korean Fract Soc. 2008;21(3):244-54. https://doi.org/10.12671/jkfs.2008.21.3.244
- Hajek PD, Bicknell HR Jr, Bronson WE, Albright JA, Saha S. The use of one compared with two distal screws in the treatment of femoral shaft fractures with interlocking intramedullary nailing. A clinical and biomechanical analysis. J Bone Joint Surg Am. 1993;75(4):519-25. https://doi.org/10.2106/00004623-199304000-00007
- Choy WS, Park YB, Park JH, Ann TG, Ahn JS, Choi SW. Torsional characteristics between single and double distal screws in the interlocking intramedullary nailing of humeral shaft fracture. J Korean Orthop Res Soc. 1999;2(2):111-6.
- Carter DR, Beaupre GS, Giori NJ, Helms JA. Mechanobiology of skeletal regeneration. Clin Orthop Relat Res. 1998;(355 Suppl):S41-55.