Intramedullary nailing of humeral shaft fractures is still a controversial issue. The comments and experience with antegrade nailing vary from enthusiasm to criticism. Main criticisms concern the damage of the rotator cuff and articular cartilage and possible impingement syndrome. The new unreamed humeral nail (UHN) is being used for antegrade and retrograde insertion. We describe the technique of retrograde nail insertion. The nail is 6.7, 7.5, or 9.5 mm. It has one curvature of 4° at the transition proximal to second fourth. There are three interlocking possibilities at the nail base and nail tip. Interfragmentary compression is achieved through a compression device. The entry portal for nail insertion is situated above the olecranon fossa; the elbow capsule is not opened. The occurrence of a supracondylar fissure or fracture and secondary damage to the radial or axillary nerve are the most feared complications. In a series of 190 retrograde nailings, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%). All radial nerve palsies recovered spontaneously. Sixty-eight patients were followed up until fracture healing. There were five (7.4%) bone healing problems. Four of five could be solved with the use of the unreamed humeral nail in a second operative procedure, whereas the fifth required plate osteosynthesis. Function of the shoulder and elbow joint was excellent in 89.7% and 88.3% of the patients, respectively. The UHN is a valuable addition to the implants, available for operative treatment of fresh or pathologic humeral shaft fractures. Retrograde humeral nailing is a safe and reliable procedure if done properly. Bone healing problems after unreamed humeral nailing must be analyzed individually, but they can be treated with the same implant in combination with cancellous bone grafts, reaming, additional hardware, or intrafragmentary compression.
Address correspondence and reprint requests to P. M. Rommens, MD, Director, Department of Traumatology, University Hospitals of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, D-55131 Federal Republic of Germany.
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