FRACTURES OF THE SHAFT OF THE HUMERUS

This study is based on 286 consecutive fractures of the shaft of the humerus surgically treated in the Orthopaedic Department Spedali Civili, Brescia, from November 1996 to December 2001. Fractures were classified accordingly to AO System. A peculiar group was represented by 33 (11.5%) complex and multifragmental fractures, where the fracture involved either the shaft and the proximal metaphysis and epiphysis. Fractures were always treated by plate and screws when a deficit of the radial nerve was present, in order to allow neurolysis or nervous graft. Fractures without radial nerve lesion were treated either by plate or by endomedullary nail. In the latter group two typed of nail were used: rigid, reamed, Kuntscher nail inserted through the proximal epiphysis elastic nail, type Marchetti-Vicenzi, inserted through a posterior, distal humeral approach. Patients were evaluated with a follow-up of a least 1 year. The rate of fracture consolidation, was similar in the group 1 rigid nail (96.5%) and plate (96.9%), while lower in the group of elastic nail (89.1%). Also time of consolidation and functional recovery was similar in the first two groups. Particular problems presented by the group of complex fractures required a differentiated post-surgical treatment, with plaster cast or orthopaedic devices used as adjuvant mode of immobilization. All except one of these cased consolidated in a larger lapse of time (mean 4.5 months) with the following functional results: 36.5% very good; 18.1% good; 9.1% fear; 36.3% poor. A selection of the technical solution adopted is presented.