Fixation stability of comminuted humeral shaft fractures: locked intramedullary nailing versus plate fixation. 2002

Andrew L Chen, and Thomas N Joseph, and Phillip R Wolinksy, and Nirmal C Tejwani, and Frederick J Kummer, and Kenneth A Egol, and Kenneth J Koval
Musculoskeletal Research Institute, Hospital for Joint Diseases Orthopaedic Institute New York, New York 10033, USA.

BACKGROUND This study compared the fixation stability of two treatments for humeral shaft fractures with segmental bone loss during cyclic, physiologic loading. METHODS Six matched pairs of human humeri received either a 10-hole broad dynamic compression plate or a locked antegrade inserted humeral nail applied to a humeral diaphyseal osteotomy with a 1.5-cm gap defect. The bone-implant humeral constructs were axially loaded for 10,000 cycles at 250 N and 500 N, with measurements of gap displacement and calculation of construct stiffness. The specimens were then loaded to failure. RESULTS Cyclic loading showed no difference between the two groups for average gap displacement or construct stiffness. The intramedullary nail constructs failed by humeral shaft splitting (n = 4) or head cut-out (n = 2) at an average of 958.3 N, whereas the plate constructs failed by humeral shaft splitting and screw pull-out (n = 3) or plate bending (n = 3) at an average of 641.7 N (p < 0.001). CONCLUSIONS Although both methods offer similar fixation stability under physiologic loads, the higher load to failure demonstrated by intramedullary nail fixation may have implications for the patient with multiple injuries for whom partial weightbearing on the injured upper extremity may be necessary.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D001858 Bone Nails Rods of bone, metal, or other material used for fixation of the fragments or ends of fractured bones. Bone Pins,Bone Nail,Bone Pin,Nail, Bone,Nails, Bone,Pin, Bone,Pins, Bone
D001860 Bone Plates Implantable fracture fixation devices attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as bone heals. (UMDNS, 1999) Bone Plate,Plate, Bone,Plates, Bone
D004868 Equipment Failure Failure of equipment to perform to standard. The failure may be due to defects or improper use. Defects, Equipment,Device Failure,Failure, Equipment,Malfunction, Equipment,Medical Device Failure,Misuse, Equipment,Device Failure, Medical,Device Failures, Medical,Failure, Medical Device,Failures, Medical Device,Defect, Equipment,Device Failures,Equipment Defect,Equipment Defects,Equipment Failures,Equipment Malfunction,Equipment Malfunctions,Equipment Misuse,Equipment Misuses,Failure, Device,Failures, Device,Failures, Equipment,Malfunctions, Equipment,Misuses, Equipment
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D005594 Fracture Fixation, Intramedullary The use of nails that are inserted into bone cavities in order to keep fractured bones together. Intramedullary Nailing,Nailing, Intramedullary,Osteosynthesis, Fracture, Intramedullary,Fixation, Intramedullary Fracture,Fixations, Intramedullary Fracture,Fracture Fixations, Intramedullary,Intramedullary Fracture Fixation,Intramedullary Fracture Fixations,Intramedullary Nailings,Nailings, Intramedullary
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006810 Humeral Fractures Fractures of the HUMERUS. Humeri Fractures,Humerus Fractures,Fracture, Humeral,Fracture, Humeri,Fracture, Humerus,Humeral Fracture,Humeri Fracture,Humerus Fracture
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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