Review Question - QID 3219

Humeral shaft fractures treated with antegrade intramedullary nailing (IMN) have a higher risk of receiving an additional operation compared to those treated with plate fixation as seen in Figures A and B. Additionally, there is a higher incidence of shoulder impingement following IMN compared to plate fixation. There has been no difference found between the incidence of infection, elbow pain or radial nerve injury when comparing the two treatment options. Blood loss is not lower in an open case compared to nailing.

In a meta-analysis of 3 randomized studies comparing compression plate fixation to IMN fixation of humeral shaft fractures, Bhandari et al, found a significant relative risk reduction of 74% to reoperation with the use of plates and screws versus IMN. They also found a relative risk reduction of 90% in shoulder impingement with the use of plates and screws versus IMN. No significant difference was found between the two regarding rates of infection and/or radial nerve palsies.

In a prospective randomized study comparing IMN fixation to plate fixation in humeral shaft fractures, McCormack et al, also showed a significantly higher rate or reoperation in patients treated with IMN fixation. They also showed no difference in functional outcome or pain scores between the two groups. There were more nonunions in the IMN group in these studies, but the numbers were small and it did not reach statistical significance. Previous studies have shown higher nonunion rates in the IMN patients.