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Increased shoulder impingement
6%
147/2376
No difference in rate of union
7%
158/2376
Increased shoulder range of motion
67%
1600/2376
No difference in rate of radial nerve injury
12%
291/2376
Increased risk of revision surgery
164/2376
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The radiograph shows a humeral shaft fracture treated with an intramedullary nail (IMN). It is important to note that the answer to this question continues to evolve as more data and studies are performed. McCormack prosepectively randomized 44 humeral shaft fractures to treatment by intramedullary nailing vs. dynamic compression (DCP) plating and found the risk of shoulder impingement, iatrogenic comminution, and nonunion were higher in the nail treatment group resulting in a higher revision rate. They found no significant differences in shoulder/elbow function, VAS pain scores, ROM, or time to return to normal activity. Chapman et al in their prospective randomized trial between IMN and plate fixation found that the IMN group had higher rates of post operative shoulder pain and a slower time to fracture union. The ORIF had faster time to union, but reduced elbow range of motion. Both studies show the effectiveness of IMN and ORIF in the treatment of humeral shaft fractures. More recent meta-analysis such as by Ma et al show that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation.
2.7
(44)
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