Treatment Of Adult Humeral Shaft Fractures Using Titanium Elastic Nail System

Introduction: Humeral shaft fractures can be treated both conservatively and surgically, options being plate osteosynthesis and intramedullary nailing. Titanium elastic nail system (TENS) that act as load sharing and stress shielding devices has advantages in terms of being minimally invasive, no risk of radial nerve palsy, preserving fracture hematoma and avoids complications like malunion, delayed union, rotational problems and joint stiffness seen with fractures managed non-operatively. We studied the rate and time of union along with the functional outcome and advantages/shortcomings of such fractures using TENS in our center.

Methods: This prospective study was done in Nepalgunj Medical College Hospital, Nepalgunj between January 2018 to January 2019. It included 43 patients (age >18 years) with closed or open (grade 1) acute traumatic diaphyseal fractures of humerus. All fractures were fixed with two titanium elastic nails of appropriate size in a retrograde fashion from distal humerus using C-arm under general anesthesia. Cases were followed up at 2, 4, 8 weeks and 3, 6, 12 months after surgery and functional outcome was evaluated using Constant shoulder score and Mayo elbow performance score at 6 months. Data were entered in structured pro forma and statistical analysis was carried out using SPPS 20.0.

Results: Out of 43 cases, mean age of patient was 35.39 years (range 21-61 years). 23 (53.5%) were males and 20 (46.5%) were females. 35 (81.4%) cases had closed fracture and 8 (18.6%) had grade I open fracture. Fractures were of proximal 3rd in 13 (30.23%) cases, middle 3rd in 19 (44.18%) and distal 3rd in 11 (25.58%) cases. All 43 (100%) cases were operated by closed technique. Average duration of surgery was 15.48±5.5 minutes (ranging 9-31 minutes).  Average hospital stay was 1.9±0.6 days (ranging 1-3 days). Radiological union was achieved in 12.4±2.7 weeks (8-24weeks). Functional outcome in final follows up at 6 month using Constant Shoulder Score was excellent in 40 (93.02%) cases, good in 2 (4.6%) and fair in 1 (2.3%) case. Mayo elbow score was excellent in 41 (95.34%) cases and good in 2 (4.6%) cases. Superficial surgical site infection was seen in 2 cases (4.6%) and exposure of nail tip and neuropraxia was seen in 1 case. Radiological union was seen in 100% patients at final follow up after 1 year.

Conclusion: TENS is a superb minimally invasive option in treatment of adult diaphyseal humerus fractures with excellent and timely union with minimal complications and preserving joint function.