[Ante- and retrograde intramedullary nailing of humerus fractures]

Abstract

Objective: Safe and definitive stabilization of fully displaced, unstable fractures of the humerus which cannot be fixed conservatively; plaster cast: subcapital humerus fractures, fractures of the shaft, and supracondylar fractures.

Indications: These depend on two major factors: first, on the morphology (strongly displaced transverse fractures, long oblique and spiral fractures, and comminuted fractures) and the stability of the fracture, and second, more often on socioeconomic aspects and comfort. Therefore, absolute and relative indications are known.

Contraindications: Stable and undisplaced fractures.

Surgical technique: Follows the rules and principles of the ESIN technique (elastic stable intramedullary nailing). Preparation of the lateral/radial entry points; opening of the medullary canal with an awl or drill; introduction of both precontoured nails, of which one is C-shaped, and the other S-shaped.

Postoperative management: No plaster cast or splint necessary, always functional postoperative treatment; exceptions are pain or anxiety of the child or parents (arm sling).

Results: In case of correct indication and operative technique, an optimal result is to be expected; the responsibility for possible failures lies always on the surgeon!