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Complications of Interlocking Intramedullary Nailing for the Humeral Shaft Fracture
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Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jong Keon Oh, Sang Hun Ko, Seung Wook Jeong
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J Korean Soc Fract 1997;10(3):669-677. Published online July 31, 1997
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DOI: https://doi.org/10.12671/jksf.1997.10.3.669
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 Abstract
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- Several advantages of intramedullary nails over plates and external fixators have led to an anpansion of the surgical indications for humeral shaft tractures. But, various morbidities due to proximity of several important structures, such as rotator cuff and radial nerve, follwed the operation. We reviewed our experience with 23 cases of humeral shaft fractures that were treated by interlocking intramedullary nailing to evaluate the pitfalls and the complications of this technique. Fifteen men and 8 women were followed for average 19.5 months. Twenty one (91.3%) of them had midshaft fractures. According to AO/ASIF classification, type A was most common(60.9%), and followed by type B(26.1%) and type C(13.O%). Eighteen of them had associated injuries - 5 radial nerve palsies, 1 Volkmans ischemic contracture, and 14 had fracture of other sites. Indications for interlocking intramedullary nailing were unsatisfactory reduction after closed reduction, fracture of the ipsilateral upper extremity, segmental fractures, and multiple injuries. The operation was performed average 6.7 days after injury. The final results were evaluated with radiographs for quality of union and with physical examination for functional status of the shoulder. There were four cases of complication associated with increase morbidity. A post operative radial verve palsy, associated with the distal interlocking screw fixation was developed due to inappropriately short nail insertion. And in one case, fracture healing was delayed due to distraction of the fracture gap after nailing. In another case subacromial impingement was developed secondary to protruded nail tip because the length was thought be the common underlying causative factor. Finally there was a case of iatrogenic fracture at the site of distal interlocking screw fixation and it was thought to be a technical problem. The results gave us the conclusion that inappropriate nail length was the common underlying causative factor of the complications. Therefore in the interlocking IM nailing for the humeral shaft fractures, accurate measurment of nail length is one of the most cirtical factor for the good final result.
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The Treatment of Supracondylar Fracture of The Humerus in Children
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Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Cheol Min Kim, Sang Hoon Ko, Seung Wook Jeong
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J Korean Soc Fract 1997;10(2):393-400. Published online April 30, 1997
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DOI: https://doi.org/10.12671/jksf.1997.10.2.393
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Abstract
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- Supracondylar fracture of distal humerus is up to 60% of all fractures around the elbow in children. Complications of this fracture include nerve injury, arterial injury, skin slough, Volkmanns ischemic contracuture, and changes in carrying angle. Many different treatment methods to minimize these complications have been devised. Recently, closed reduction and percutaneous pinning with K-wire is most widely used in treating supracondylar fractures in children exept in some rare cases such as unreducible fracture by closed reduction. However, troublesome changes in the carrying angle which do not interfere with function but the appearance of the arm is unsatisfactory, continue in approximately 30% of most series. We reviewed 59 cases which were treated by closed reduction and percutaneous pinning in supracondylar fracuture of the humerus. The purpose of our study is to evaluate the cosmetic and functional results and complications and to analysis the relationship between the stability of reduction and method of pinning.
The results are as follows; 1) There were many cosmetic problems, actually. Change over 10 degrees in carrying angle compared to the normal site was as high as 10 cases(17%) of 59 cases.
2) There was no functional problem such as limitatioin of motion.
3) There was no significant complication.
4) The cross pinning fixation was more stable than lateral pinning fixation only.
5) Accurate anatomical reduction is required to prevent unsatisfactory result regardless the treatment method.
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