ArticleOperative Orthopadie und Traumatologie2021
[Antegrade and retrograde nailing of humeral shaft fractures].
Article in Operative Orthopadie und Traumatologie, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed, 4 citations in OpenAlex.
- Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- Humerus shaft fractures, approaches and management.Journal of clinical orthopaedics and trauma · 2023Review
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Authors and funding
2 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveRestoring humeral shaft alignment using direct or indirect reduction techniques with subsequent intramedullary stabilisation with an antegrade or retrograde inserted humeral nail. Achieving osseous union and restoration of painfree upper arm function. INDICATIONS: Antegrade: Humerus shaft fractures located in the proximal 2/3 of the humerus. Combined fractures of the ipsilateral proximal humerus and humerus shaft. Segmental fractures of the humerus shaft. Pathological fractures or osteolysis (palliative indication). Retrograde: Humerus shaft fractures located in the middle and distal part of the humerus diaphysis. CONTRAINDICATIONS: Acute infection in the area of the surgical approach; polytrauma with acute life-threatening haemodynamic instability. SURGICAL TECHNIQUE: In the antegrade technique: anterolateral acromial approach. Determination of the correct nail entry point on the humeral head. Incision of the rotator cuff with longitudinal split of the fibres. Closed or semi-open fracture reduction. Insertion of an intramedullary nail with an appropriate length and diameter. Interfragmentary compression when required. Proximal and distal static interlocking with at least 2 bolts on each side. In the retrograde technique, the nail is inserted after opening of the medullary cavity directly proximal to the olecranon fossa. POSTOPERATIVE MANAGEMENT: Functional aftertreatment with passive and active-assisted exercises during the first 3 weeks. Subsequent active exercises avoiding forced rotation of the arm. Sports activities and severe stress are avoided for 3 months. Postoperative radiographs as well as after 2, 6 and 12 weeks.
resultsVery good healing results with excellent clinical and radiological healing are achieved in more than 90% of cases after both antegrade and retrograde nailing. Intraoperative problems that have been reported in up to 40% of cases occurred mainly with former generation nails or were attributable to technical errors. Correspondingly, with the closed reduction technique postoperative infections are rare (< 3%). Undesirable distraction at the fracture site is successfully corrected by intraoperative interfragmentary compression. Success and complication rates after intramedullary nailing and plate fixation are not significantly different. Functional shoulder-related problems may occur after antegrade nailing, whereas elbow problems may occur after retrograde nailing.
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