The Journal of Bone and Joint Surgery, Vol 66, Issue 5 639-646, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Intramedullary fixation of humeral shaft fractures
PJ Stern, DA Mattingly, DL Pomeroy, EJ Zenni and JK Kreig
In this paper we document seventy fractures of the humeral shaft that were
treated by intramedullary fixation between 1970 and 1981. Complications
developed in forty-seven (67 per cent) of the fractures, and forty-five (64
per cent) required at least one additional operative procedure. Of the
sixty fractures that were internally fixed within six weeks after injury,
nine (15 per cent) had a delayed union and five (8.3 per cent) had a
non-union, two of which persisted despite subsequent surgery. Three of the
ten fractures that were internally fixed more than six weeks after injury
never united despite additional procedures that were done to secure union.
Delayed union and non-union were more common in open fractures (33 per
cent) than in closed fractures (21 per cent), and with open reduction (39
per cent) than with closed or so-called semi-open reduction (9 per cent).
Deep infection occurred in three (5 per cent) of the fractures and was more
common in open (17 per cent) than in closed fractures (2 per cent). One of
the three open fractures that were treated by immediate fixation became
infected, as compared with only one of the nine open fractures treated by
delayed fixation. Painful adhesive capsulitis of the shoulder developed in
thirty-four (56 per cent) of the patients who had fractures treated with
distally directed pins, but motion of the elbow was not restricted in the
nine patients with fractures treated with proximally directed pins.
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