Treatment of fracture of shaft of humerus by Ender nailing: A report of 43 cases

The authors report a retrospective series of 43 consecutive fractures of the humeral shaft treated with closed unreamed medullary Ender nails. 36 fractures were closed and 7 were open. One nail was used in 11 cases, 2 nails in 29 cases, and 3 nails in 3 cases of distal shaft fractures. After surgery a sling and swathe were applied for 4 weeks and circumduction exercise of the shoulder 3 times per day was prescribed one week after surgery to prevent stiff shoulder. The results of treatment in all cases were satisfactory, though there were 6 cases of delayed union secondary to distraction of the fracture gap. External callus was noticed at 6.2 weeks on average. The average overall clinical union time was 9.3 weeks. In 5 delayed union cases fracture union took more than 13 weeks. No complications developed during the nailing procedure. Radial nerve palsy, which developed in a patient 2 days after fracture, recovered spontaneously after nailing. Longer nails which hit the end of the medullary canal of the distal fragment distracted the fracture gap, and later migrated proximally in conjunction with reduction of distraction of the fracture gap. Distraction resulted in delayed union in 5 cases, and in a case of segmental shaft fracture, the distal fracture was still ununited at 9 months. Therefore, we recommend using the proper size of nail to avoid the distraction effect of the inserted nail, and to use 2 nails for better fixation. However, when intramedullary Ender nailing was properly performed, a single nail also could maintain consistently good anatomic reduction, especially of transverse fractures, and bring successful results. Ender nailing was found to be an easy procedure to perform, and provided effective immobilization of humeral shaft fractures.