Intramedullary nailing of humeral shaft fracture with sign in nails at mbeya zonal hospital, Tanzania

Title : Intramedullary nailing of humeral shaft fracture with sign in nails at mbeya zonal hospital, Tanzania

Abstract:

Background: Humeral shaft fractures have been treated with pates and screws for decades. Intramedullary nailing with humerus nails is evolving as another good choice for fixation of humerus fractures. Intramedullary nails offer less soft tissue dissection, less chance of radial nerve injury as minimal incision is enough and early range of motion. We studied union and functional outcome of humerus shaft fractures managed with fin nails manufactured by SIGN which are meant for femur because we do not have humeral nails in Tanzania

Methodology: We conducted a retrospective study of 48 patients that have been followed for 12 months or more. We included patients of 16 years and above with closed humerus fractures, excluded all with pathological and delayed fractures. We operated them supine without image intensifier, reaming was done manually, nail inserted and locked with two screws proximally.

Results: Mean time for surgery was 35 minutes, union was achieved in all but 3(6.25%) patients at mean time of 4 months. We had nonunion among old patients with large humeral canals. No case of infection or radial nerve palsy was reported. The mean clinical outcome scores that we studied in this study included American Shoulder and Elbow Society (ASES): 87.2, Constant-Murley Score: 85.1 and Penn Shoulder Score: 82.7.

Conclusion: Intramedullary nailing of humeral shaft fractures with fin nails give good results terms of healing and function. Surgery time is short which reduced morbidity and hence patients start physiotherapy early with less demands to analgesics.

Relevance of the Study

1. SIGN fin nail can safely be used in management of Humeral shaft fractures with good results, in Sub Saharan Africa humerus nails are not available and SIGN fin nail gives a better alternative
2. Nailing humerus allows for shorter surgical time which reduced blood loss and chances of infection
3. Intramedullary nailing can be done in supine position without image machine and guide wire, minimal incision for manipulation to get reduction is enough, anterolateral incision

Biography:

Dr Lunemo Sakafu is an Orthopedic Surgeon working in Tanzania. He graduated at Muhimbili University of Dar es salaam 2008 and worked as a general practitioner on two different government hospital. He joined the residency course for Orthopedic and Trauma at Muhimbili University in 2013 and graduated in 2016, since then he has been working as an Orthopedic and Trauma surgeon at Mbeya Zonal hospital of Tanzania. He did fellowship on Joint Replacement in Germany in 2017 and trained under Prof. Stefan Sell. At the moment he also works as a clinical lecturer at Mbeya University College of Health Sciences.