Chapman, J Orthop Trauma 2000 - Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intramedullary Nails versus Plates

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Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intramedullary Nails versus Plates

Chapman, Benca, et al.·J Orthop Trauma·2000·378 citations·RCT

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Purpose

To compare the clinical and radiographic results for locked intramedullary (IM) nails and plates used in the treatment of humeral diaphyseal fractures.

Methods

Design: Prospective randomization by sealed-envelope technique of 84 patients into 2 study groups: those treated by intramedullary nailing (IMN group; n = 38) and those treated by compression plating (PLT group; n = 46).

Setting: Patients admitted consecutively to a university-affiliated Level I trauma center.

Patients: All skeletally mature patients admitted to Harborview Medical Center with acute humeral shaft fractures requiring surgical stabilization. Fractures of the diaphysis were defined as being at least three centimeters distal to the surgical neck and at least five centimeters proximal to the olecranon fossa.

Intervention: Treatment with locking antegrade intramedullary humeral nails (Russell-Taylor design [Smith and Nephew Richards]) or with 4.5-millimeter dynamic compression and limited contact dynamic compression plates (AO design [Synthes]).

Main Outcome Measures: Clinical outcome measurements included fracture healing, radial nerve recovery, infection, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion.

Results

Follow-up averaged 13 months.
42 fractures (93 percent) in the PLT group were healed by 16 weeks versus 33 fractures (87 percent) in the IMN group (p = 0.70).
Shoulder pain and a decrement in shoulder range of motion (ROM) were significant associations with IMN (p = 0.007 for both variables) but not with PLT.
A decrement in elbow ROM was significantly associated with PLT (p = 0.03), especially for fractures of the distal third of the diaphysis, whereas elbow pain was not (p = 0.123).
The sum of other complications demonstrated nearly equal prevalence for both treatment groups.

Conclusions

For patients requiring surgical treatment of a humeral shaft fracture, intramedullary nailing and compression plating both provide predictable methods for achieving fracture stabilization and ultimate healing.

Copyright remains with the authors and publisher.

Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intramedullary Nails versus Plates.

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Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intramedullary Nails versus Plates

Chapman, Benca, et al.·J Orthop Trauma·2000·378 citations·RCT

|

Purpose

To compare the clinical and radiographic results for locked intramedullary (IM) nails and plates used in the treatment of humeral diaphyseal fractures.

Methods

Design: Prospective randomization by sealed-envelope technique of 84 patients into 2 study groups: those treated by intramedullary nailing (IMN group; n = 38) and those treated by compression plating (PLT group; n = 46).

Setting: Patients admitted consecutively to a university-affiliated Level I trauma center.

Patients: All skeletally mature patients admitted to Harborview Medical Center with acute humeral shaft fractures requiring surgical stabilization. Fractures of the diaphysis were defined as being at least three centimeters distal to the surgical neck and at least five centimeters proximal to the olecranon fossa.

Intervention: Treatment with locking antegrade intramedullary humeral nails (Russell-Taylor design [Smith and Nephew Richards]) or with 4.5-millimeter dynamic compression and limited contact dynamic compression plates (AO design [Synthes]).

Main Outcome Measures: Clinical outcome measurements included fracture healing, radial nerve recovery, infection, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion.

Results

Follow-up averaged 13 months.
42 fractures (93 percent) in the PLT group were healed by 16 weeks versus 33 fractures (87 percent) in the IMN group (p = 0.70).
Shoulder pain and a decrement in shoulder range of motion (ROM) were significant associations with IMN (p = 0.007 for both variables) but not with PLT.
A decrement in elbow ROM was significantly associated with PLT (p = 0.03), especially for fractures of the distal third of the diaphysis, whereas elbow pain was not (p = 0.123).
The sum of other complications demonstrated nearly equal prevalence for both treatment groups.

Conclusions

For patients requiring surgical treatment of a humeral shaft fracture, intramedullary nailing and compression plating both provide predictable methods for achieving fracture stabilization and ultimate healing.

Copyright remains with the authors and publisher.

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