To Determine the Efficacy of Locking Compression Plating in Comparison with Intramedullary Nailing for Humeral Shaft Fractures at a Tertiary Care Hospital in Karachi, Pakistan

Abstract

Objective: The purpose of our study is to compare the effectiveness, surgical outcome and complications of locking compression plating as compared with intramedullary nailing for the purposes of fixation of humeral shaft fractures in the adult population. Methodology: The type of study is a prospective randomized controlled trial, which was carried out for a period of three years from Jan 2012 to December 2014, at a tertiary care hospital in Karachi Pakistan. Patients coming to the hospital via the A&E department with radiographic evidence of a humeral shaft fracture were included in the study. 50 patients were selected for the study, who were randomly divided into two groups, group A (n=25) comprised of patients who underwent intramedullary nailing procedure, while group B (n=25) patient underwent compression plating for the fixation of the humeral fracture. The surgical outcome was assessed based on the operative time, intra operative blood loss, the time of hospital stay, the time required for the union of bone, functional outcome and complications. (American shoulder and elbow surgeons score) ASES and the constant score was used to assess the functional outcome of patients. Results: According to our study, the operative time, hospital stay and intra operative blood loss was much lower in group A (the intramedullary nail group) as compared to those in the group B (locking compression plate group). The rate of bone union, constant and ASES score did not show any significant difference. The union time for group A was lower as compared to group B. Complications such as radial nerve palsy were observed to be associated more with the locking compression plate as compared with the group of patients who underwent intramedullary nailing. Conclusion: According to our study the intramedullary nailing technique for the repair of humeral shaft fractures is a superior technique as compared to the locking compression plate, as it has decreased incidence of blood loss during the procedure, less time required for the procedure, less time of hospital stay and union of bone. It also has a low incidence of complications.