Out of 47 patients, 23 patients underwent internal fixation by IMN and 24 by DCP. Two patients from the IMN group were lost to follow-up. Thus, the final assessment was done for 21 patients in the IMN group and 24 patients in the DCP group.
Age The mean age of patients with IMN fixation was 39 years (SD -12) and 35 years (SD -11.5) for those who underwent DCP fixation (P>0.05).
Sex In group A (IMN ), 20 were males (86.9%) and 3 females (13%), while in group B (DCP), 19 were males (79.2%) and 5 females (20.8%) (see Table ).
Baseline characteristics of two groups
Mode of injury
Most of the patients sustained injuries in road traffic accidents [17 in group A (73%) and 16 in group B (66.6%)]. The second most common cause of injury was falling on the ground (four in group A and seven in group B) (see Table ).
Duration of injury Most of the cases of both groups were more than 7 days old because initially conservative methods had been tried, but all were less than 3 months old.The mean duration of injury for group A (IMN) was 45 (SD -29) days, while for group B (DCP) it was 38 (SD -19; P>0.05).Two patients from the IMN group were lost to follow-up. Thus, the final assessment was done for 21 patients in the IMN group and 24 patients in the DCP group.
Follow-up The mean period of follow-up was 14.3 months (6–33 months) in both groups.
All patients of both groups were able to return to their previous jobs within 6 months, except for three patients of group A and three patients of group B who developed non union. Thus, the functional result was good in 85.7% of the cases in group A (IMN) and 87.5% of the cases in group B (DCP).
No statistically significant difference was found in the mean ASES score between the two groups [0.44 in group A (IMN) and 45 in group B (DCP); P>0.05)].
Out of 21 patients available for follow-up in group A (IMN) and 24 patients in group B (DCP), 18 (85.7%) united in group A and 21 (87.5%) in group B (P>0.05).
The average union time for group A was 6.3 weeks compared to 8.9 weeks for group B (P<0.001).
There was no significant difference between the union rate and the incidence of non union between the two groups.
The union time was found to be significantly lower in patients with IMN as compared to DCP.
Five patients of group B managed by DCP (20.8%) developed infection. Two of them were superficial infections that responded well to antibiotics and later healed uneventfully. Three patients in this group developed deep-seated infection and discharging sinuses. These were treated with long-term antibiotics, and once fracture union was achieved, the plate was removed and the sinus tract excised. Eventually, the sinus tract healed, but left an unsightly scar over the arm.
Only one patient (4.7%) of group A developed deep-seated infection and subsequent non union. This was managed by removal of the nail followed by reinsertion of the nail and bone grafting once the infection had subsided.
Seven (33.3%) patients of group A (IMN) developed shortening of an arm from 1.5–4 cm compared to 1 (4.1%) in group B (DCP).
Non union occurred in three (14.3%) of the IMN compared to three (12%) of the DCP group.
Implant failure occurred in one case (4.7%) of IMN due to breakage of a nail at the site of the distal locking screw.
One patient (4.7%) with IMN developed axillary nerve injury, which was due to the fact that the proximal incision extended 6–7 cm beyond the acromian process. One patient (4.1%) in the DCP group had a radial nerve injury.
Four patients with IMN had restriction of full abduction of the shoulder because of impingement of the nail. They were managed by removal of the nail once the fracture was united.
There were six patients in group A (IMN) and four in group B (DCP) with open fractures (Gustilo 1 or 2a). All had an initial debridement and early internal fixation. Two patients in group B developed superficial infection, which responded well to antibiotics. All of them united well (the average union time for group A was 7 weeks compared to 8.8 weeks for group B) with no complications (see Table ).