Humeral shaft fracture: Outcomes of percutaneous antegrade intramedullary nailing using the long Telegraph® nail with dynamic distal locking

Abstract

Introduction: Antegrade intramedullary nailing (IMN) in humeral shaft fracture (HSF) has been abandoned by certain orthopedic surgeons due to rotator cuff injury caused by curved nails, and to unreliable anatomical results. The purpose of this study was to report outcomes of straight percutaneous intramedullary nailing with dynamic distal locking in HSF. Hypothesis: Percutaneous antegrade intramedullary nailing using a long straight nail with dynamic distal locking improves radiological and functional outcome in HSF. Material and methods: A retrospective study was carried out, between january 2008 and june 2018, about 76 consecutive patients undergoing straight percutaneous antegrade IMN with dynamic distal locking for isolated closed displaced HSF. Eighteen patients were excluded; 36 were reviewed in June 2018 to assess Constant score. Results: There were 35 women and 23 men, with a mean age of 53 years. All fractures were closed: 36 type A, 16 type B and 6 type C according to the AO/OTA classification. Healing was achieved in 97% of cases, at a mean 13 ± 3 weeks. There were no cases of infection or secondary nerve injury. The mean Constant score was 78 ± 13. Discussion: Surgical treatment of humeral shaft fractures is a subject of discussion, without any consensus. Based on our experience, percutaneous antegrade IMN with dynamic distal locking improves anatomical and functional outcomes, provided that the surgical technique is mastered, which requires a learning curve. Level of evidence: IV, retrospective study.