Year: 2026 | Month: September | Volume: 16 | Issue: 9 | Pages: 150-159
DOI: https://doi.org/10.52403/ijhsr.20260917
Functional and Radiological Outcomes in Humeral Diaphyseal Fractures: A Comparative Observational Study of Intramedullary Nailing Versus Dynamic Compression Plating
Manjeera Rednam1, Kalyan Chakravarthy A2, Simhachalam Naidu D3, A Chaitanya Naidu4
1,2,3Assistant Professor, 4Post Graduate, Department of Orthopaedics,
Andhra Medical College, Visakhapatnam, India.
Corresponding Author: Dr. Manjeera Rednam
ABSTRACT
Background: The optimal fixation method for diaphyseal fractures of the humerus remains debated. Both plate osteosynthesis and intramedullary interlocking nailing are widely practiced, but comparative evidence on functional outcome is limited. This study compared the functional and radiological outcomes of interlocking intramedullary nailing and plate osteosynthesis in the operative management of humeral shaft fractures.
Methods: This prospective observational study was conducted in the Department of Orthopedics, Andhra Medical College and King George Hospital, over 18 months (January 2022 to July 2023). Thirty humeral shaft fractures in 28 adult patients (age >18 years) with closed, simple, comminuted or segmental fractures, including polytrauma cases, were allocated alternately to plate osteosynthesis (15 patients, 15 fractures) or antegrade interlocking intramedullary nailing (13 patients, 15 fractures; 2 patients had bilateral injuries). Patients with compound fractures, pathological fractures, neglected nonunion, infected fractures or severe medical comorbidity were excluded. Radiological union, time to union, shoulder and elbow range of motion, complications, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded at a minimum follow-up of 18 months.
Results: Mean age was 41.5±16.4 years in the plating group and 47.6±12.2 years in the nailing group (p=0.27); the plating group had a male preponderance (80.0% vs 53.8%, p=0.23). All 30 fractures united; mean time to union was 18.1±1.8 weeks with plating and 18.0±1.4 weeks with nailing (p=0.91). Complications occurred in 4/15 (26.7%) plated fractures (2 superficial infections, 2 radial nerve palsies, both fully recovered) versus none in the nailing group (p=0.10). Residual shoulder pain was reported by 2/15 patients after plating and none after nailing (p=0.48). The mean DASH score was significantly better after nailing (3.94±2.40) than after plating (14.02±11.55; p=0.005).
Conclusion: Plate osteosynthesis and interlocking intramedullary nailing both reliably achieve union of humeral diaphyseal fractures with comparable time to union. Interlocking nailing was associated with significantly better DASH functional scores and a trend towards fewer complications, and may be preferable when minimally invasive fixation, preservation of fracture biology and early rehabilitation are priorities, particularly in polytrauma and osteoporotic bone.
Key words: Humeral shaft fracture; Intramedullary nailing; Plate osteosynthesis; DASH score; Functional outcome; Radiological union