Does double distal locking reduce non-union rates in intramedullary nailing for humeral shaft fracture? - 13/06/24

Doi : 10.1016/j.otsr.2024.103913

Jules Levasseur ^a, Pierre Bordure ^b, Yvon Moui ^c, Guillaume David ^a, Louis Rony ^a,⁎
^a Département de chirurgie osseuse, CHU d’Angers, 4, Rue Larrey, 49933 Angers cedex 9, France
^b Service de chirurgie de l’épaule, clinique Saint-Léonard, 18, rue de Bellinière, 49800 Trélazé, France
^c Service de chirurgie orthopédique, centre hospitalier du Mans, 194, avenue Rubillard, 72037 Le Mans, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 13 June 2024

Abstract

Introduction

Intramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10–20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking.

Hypothesis

Nailing with double distal locking decreases non-union rates compared to single or no locking.

Material and methods

This single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs).

Results

There were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (p=0.32). Constant score at 6 months was significantly different between the 3 groups (p=0.01). Group 2 used more NSAIDs than the other groups (39.1% vs. 20.0% in group 1 and 33.3% in group 3; p=0.37).

Discussion

Non-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation.