J Korean Fract Soc.  2013 Oct;26(4):299-304. 10.12671/jkfs.2013.26.4.299.

Treatment of Humeral Shaft Fracture with Retrograde Intramedullary Nail

• Choi KB
• Kang SH
• Lee YM
• Song SW
• Kim YJ

• KMID: 2183831
• DOI: http://doi.org/10.12671/jkfs.2013.26.4.299

Abstract

PURPOSE
The purpose of this study was to report the outcome of treatment of humeral shaft fracture with retrograde intramedullary nail of advanced insertion opening.
MATERIALS AND METHODS
From April 2005 and August 2012, 22 patients with a humeral shaft fracture were treated by a single surgeon using the technique of retrograde intramedullary nail at Department of Orthopedic Surgery, Yeouido St. Mary's Hospital (Seoul, Korea). To avoid causing fractures at the insertion site, the entry point was more distally located than conventionally, and was extended proximally to include the proximal marginal cortex of the olecranon fossa. The outcome was evaluated clinically and radiologically.
RESULTS
The mean period of achievement of bony was 5.8 months (4-11 months). Additional fixations were needed in one patient with intraoperative lateral condylar fracture and 2 patients with postoperative nonunion. There were no limitations of movement or pain in the shoulder joint, and 8 cases had a 6.5degrees flexion contracture on average.
CONCLUSION
This retrograde intramedullary fixation technique using a distal entry portal near the olecranon fossa is particularly useful in humeral shaft fractures without a neurovascular injury. The risk of an intraoperative fracture (supracondylar fracture or fracture around the entry portal) can be decreased using this treatment. We recommend this technique because of the safety and the satisfactory outcome.

Keyword

Humeral shaft; Fracture; Retrograde; Intramedullar fracture fixation

MeSH Terms

Contracture
Humans
Olecranon Process
Orthopedics
Shoulder Joint

Figure

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  Fig. 1 (A) The skin was incised curvilinearly from the midline of the distal humerus to the lateral condyle. (B) After using the triceps splitting approach, (C) a cortical window was made at the superior margin of the olecranon fossa and was extended proximally about 3 cm. (D) Nail and locking screws were inserted, without an iatrogenic supracondylar fracture occurring.

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  Fig. 2 (A) Initial radiographs show a short oblique fracture of the humeral shaft area. (B) After fixation by a retrograde intramedullar nail, the fracture site was reduced, with a minimal gap. (C) At postoperative 5 months, the fracture site was completely united.

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