Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures.

OBJECTIVE To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. STUDY DESIGN Experimental study. PLACE AND DURATION OF STUDY Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. METHODOLOGY Two groups of 30 patients each were inducted. Group A (n=30) was treated with intramedullary interlocking nailing while Group B (n=30) underwent plating with dynamic compression plate (DCP). Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. RESULTS In group A, 11 patients had severe or moderate shoulder dysfunction (ASES score below 39), out of whom 8 (72%) were above 50 years. This age related disability was significant (p=0.003). Transient palsy was observed in 3 patients (10%) and mild wound infection in 2 (6%), which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups (p=0.001), especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. CONCLUSION Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction.