Intramedullary osteosynthesis for metaphyseal and diaphyseal humeral fractures in developmental age.

UNLABELLED: Diaphyseal and metaphyseal fractures of the humerus are relatively frequent in children. The treatment is often conservative, even in the case of displaced fractures for the high rate of spontaneous recovery of these fractures. The limits of nonsurgical treatment and its applications as well as the type of surgical treatment are controversial issues in the literature. The aim of this study is to review a series of metaphyseal and diaphyseal fractures of the humerus treated with intramedullary osteosynthesis, to discuss the results obtained and the problems found, and to propose some parameters that should be taken into account to choose the most appropriate osteosynthesis. The retrospective study was performed on a group of 105 proximal and distal metaphyseal fractures and of displaced diaphyseal fractures of the humerus (excluding epiphyseal trauma, supracondylar fractures, and pathologic fractures) treated from 2001 to 2005. Out of a total of 105 patients, only 22 had fracture reduction under anesthesia, followed by intramedullary osteosynthesis; in 11 cases, intramedullary osteosynthesis was performed using Kirschner wires and in the remaining 11 elastic nails were used. In all treated patients, fracture healing was achieved. In the patients treated with Kirschner wires, no complications were observed, whereas in the patients treated with intramedullary nails, there were three cases with involvement of the skin and subcutaneous layers at the nail insertion site and one case of temporary paralysis of the radial nerve disappearing spontaneously after 2 months. Considering the results obtained and the low number of technique-related complications (low anesthesiologic and infectious risk), we can conclude that intramedullary osteosynthesis is a simple, safe, and rapid method suitable at any age in childhood. LEVEL OF EVIDENCE: level IV.