Session V - Upper Extremity

Unreamed vs Reamed Interlocking Nailing of Humeral Shaft Fractures

Freddy Achecar, MD, A. Paige Whittle, MD

Campbell Clinic-University of Tennessee, Memphis, Tennessee, USA

Purpose: The purpose of this study was to compare the results of unreamed nailing of humeral shaft fractures to those of reamed nailing.

Materials and Methods: Between September of 1992 and August of 1995, 46 traumatic humeral fractures in 45 patients were treated with static-locked intramedullary nail fixation. Twenty-seven fractures were closed, and 19 were open (8 type I, 4 type II, 2 type IIIA, 1 type IIIB, and 4 type IIIC). Thirty-one fractures (67%) resulted from motor vehicle accidents, and 44 (96%) were associated with polytrauma. Four patients died from other injuries and 8 were lost to followup, leaving 34 fractures in 33 patients with an average age of 33 years (range 13 to 69 years) for inclusion in this study. Of these 34 fractures, 17 were treated with reamed intramedullary nailing and 17 with unreamed nailing. Six Biomet nails (5 reamed, 1 unreamed) and 28 Russell-Taylor nails (12 reamed, 16 unreamed) were used. Ten patients had preoperative neuropraxias, 8 of which completely resolved.

Results: Thirty-three of the 34 fractures united. Three patients had major complications: one nonunion and a preoperative radial nerve palsy in a closed fracture treated with a reamed nail that did not resolve, one preoperative radial, median and ulnar nerve palsy in a Type IIIC open fracture treated with an unreamed nail that did not resolve, and one postoperative radial nerve palsy in a closed fracture treated with a reamed nail that subsequently resolved. There were no infections and no intraoperative fractures. At an average followup of 12.6 months, 22 patients had regained full shoulder and elbow motion; the 11 patients (12 fractures) with less than full range of motion had concomitant upper extremity injuries that delayed rehabilitation. One reamed nail was removed 2 years after fracture because of shoulder impingement. Radiographic healing time averaged 3.57 months in the unreamed nail group, and 4.13 months in the reamed nail group.

Discussion and Conclusions: Although the effects of reaming in intramedullary nail fixation of femoral and tibial fractures have been well documented, little has been published about the effects of reaming in nailing of humeral fractures. The results of this study indicate that unreamed nailing of humeral fractures is as effective as reamed nailing, and because the radial nerve may be at risk during reaming, we recommend nail insertion without reaming when humeral canal diameter allows.