EVALUATION OF FUNCTIONAL OUTCOME OF INTRAMEDULLARY INTERLOCKING NAIL FIXATION FOR HUMERAL SHAFT FRACTURE

Abstract

BACKGROUND AND OBJECTIVE: - Fractures of shaft of humerus are commonly encountered, which accounts for approximately 3% of all fractures. Treatment methods for such injuries continue to progress as advances are made in both non-operative and operative methods of management. Antegrade interlocked humerus nailing for stabilization of humerus fractures was introduced many years ago and is a valid treatment option for stabilization of shaft of humerus fractures. Avoidance of complications like non-union, malunion, fracture disease, excessive soft tissue dissection and difficulty in nursing and rehabilitation in polytrauma cases allows intramedullary interlocking (IMIL) nails to successfully bridge the gap between functional bracing and plating. The objective of study is to assess the functional outcomes of intramedullary interlocking nailing in case of humerus shaft fractures by University of California Los Angeles (UCLA) scoring system and the associated complications of above mentioned procedure. METHOD: - 30 patients of age between 18-65 years admitted in orthopaedics department in R.L Jalappa hospital attached to Sri Devaraj Urs Medical College with fracture of shaft of humerus meeting inclusion and exclusion criteria were taken up for the study. Their demographic data, history, clinical examination, and details of investigations were recorded in study proforma, and then were taken for antegrade IMIL nailing. Time for recovery, ambulation time for the patient and complications of the procedure like pain, infection, joint stiffness, iatrogenic fractures, radial nerve palsy etc were documented and the patients were followed up at 1st, 3rd, and 6th month after surgery. xviii RESULT: - In this study patients age ranging from 18-65 years with mean age of 43.1±14.8 were assessed of which 22 were male and 8 were females. Fracture of middle third was most common accounting to 56.7% of the humerus shaft fractures. Most common mode of injury was RTA which was 66.7% and 60% of patients sustained injury to right side. In 83.4% patients, duration between trauma and surgery was 1-5 days and U-slab was the most common method of preliminary immobilization used in this study. Among 30 patients treated with IMIL nailing 2 cases had complication of shoulder stiffness and delayed union, one case had surgical site infection and shoulder stiffness, one case had only shoulder stiffness, one case had iatrogenic fracture of medial epicondyle of humerus, one case had implant breakage secondary to trauma post fixation. Functional outcomes were evaluated using UCLA scoring in which mean score of present study was 31.73±3.609 indicating excellent functional outcome following intramedullary interlocking nail fixation at 6-month follow-up. CONCLUSION: - Intramedullary interlocking nailing is safe and effective modality of treatment for the humerus shaft fracture with excellent functional outcome with mean UCLA score of 31.73±3.609 at 6-month follow-up. At the follow up from 1 month to 6 month UCLA score improves from fair to good and excellent in majority of participants. Further IMIL nailing is associated with less complications (maximum of which was shoulder stiffness).