Comparative Study of Functional and Radiological Outcome of Humerus Shaft Fracture Treated with Retrograde Halder Nail versus Plate Fixation.

Abstract

Introduction: This study compares and analyses the functional and radiological outcome of Halder nailing with plate fixation for humeral shaft fracture. To study, the time taken for union status in humeral shaft fractures treated with Halder intramedullary nail and plate fixation through radiological assessment and to study the functional assessment by shoulder joint range of movements after surgery.

Materials and methods: One hundred and two cases of humeral shaft fracture received in an emergency or in outpatient Department of Orthopaedics at Government Stanley Medical College and Hospital during 3-year study period of July 2021-June 2024 were included in the study.

Results: Out of 102 cases, 54 cases were selected for plate fixation, and 48 cases were selected for Halder nailing. Out of 54 plate fixation cases, 38 were male (70.37%) and 16 were female (29.62%). Radiological union status is seen at about 12-16 weeks for 35 cases (64.81%) and 16-20 weeks for 19 cases (35.18%). In some cases, complications were noted like delayed union (4 cases), wrist drop (5 cases), and non-union with implant failure in (1 case). Out of these 48 Halder nailing cases 33 were male (66.66%) and 15 were female (33.33%), 15 were right-sided (33.33%) and 33 were left-sided (66.66%). Moreover, radiological union is seen at about 12-16 weeks for 35 cases (72.91%), and 16-20 weeks for 13 cases (27.00%). In some cases, complications were observed like delayed union (2 cases), tri-wire pullout (1 case), and iatrogenic fracture (1 case).

Conclusion: Considering the excellent results and number of cases with surgical treatment of diaphyseal humeral fractures with the retrograde HALDER nailing. We conclude that HALDER nail is safe and reliable method in treating diaphyseal fractures of the humerus particularly in elderly patient with osteoporosis, polytrauma where reduction in operating time and early rehabilitation is primary objective. It is also well acceptable cosmetically as the scars are smaller when compared to the conventional plating. It lessens morbidity and complications such as post-operative wrist drop and wound infection. The shoulder impingement and supraspinatus bursitis can be reduced due to retrograde entry site and early rehabilitation program which promotes good functional outcome. The problem of non-union can be avoided by selecting appropriate nail size, avoiding distraction at the fracture site, if possible, reverse banging the nail to avoid distraction.