A prospective, comparative study of management of acute humeral shaft fractures by antegrade interlocking nail fixation and dynamic compression plating was undertaken at our institution over a period of three years (November 2001 to November 2004). The average follow-up period was one year (range 10–24 months). An informed consent from patients and departmental permission were obtained according to local hospital regulations.
Forty-five patients with closed acute humeral shaft fracture requiring operative intervention were treated with either interlocking nailing or plating procedures. A randomisation attempt was made by allocating each patient to either of the groups depending on the criteria of odd or even hospital number.
The inclusion criteria were: (1) humeral shaft fractures which required operative intervention and were treated with interlocking or plating procedures, and (2) patients of age of 18 years or more.
The exclusion criteria were: (1) the patient was aged less than 18 years, (2) pathological fractures, (3) segmental fractures, (iv) fractures within 4cm of proximal and distal end of humerus, and (5) patients who were lost to follow-up or at early stages of follow-up at the time of completion of the study (minimum follow up of six months required).
All patients had appropriate clinical and radiological assessment before a decision to offer surgical intervention was made. All fractures were classified according to the AO classification. Of the 25 patients treated by interlocking nail, three were at early stage follow-up and two were lost to follow-up at completion of the study. Of the 20 patients treated by plating, two were in early follow-up and two lost to follow-up.
After applying the inclusion and exclusion criteria, we included 20 patients of interlocking nailing and 16 patients of plating for final analysis in the study.
An antegrade interlocking technique was used with an intramedullary nail (Russell-Taylor type) and care was taken to minimise damage of the rotator cuff during nail insertion. A 3.5-mm or 4.5-mm dynamic compression plate was used in the plating group depending on the width of the bone with appropriate AO principles. The choice of surgical approach (antero-lateral or posterior) for the plating group was left to the discretion of the operating surgeon.
All patients were advised on immediate postoperative shoulder and elbow exercises and radiographs were taken at regular intervals during follow-up. Rodriguez-Merchan criteria (1995) were used to compare the postoperative results of interlocking nailing and plating procedures at follow-up. It was originally described for comparison of compression plating versus Hackethal nailing in closed humeral shaft fractures [16
]. The overall rating of excellent, good, fair and poor outcomes was based on scores of shoulder and elbow movements along with pain and disability after the procedure (see Table ). In situations where any two different criteria fell into separate categories, the lower category was selected to classify the outcome.
Criteria for evaluating functional results