Treatment of humeral shaft fractures with the Marchetti nail: 50 cases

Purpose of the study There is no universal agreement concerning the most appropriate method for treating humeral shaft fractures. Orthopedic treatment was long proposed due to the risks of surgical management. Screwed plate fixation raises the risk of infection, neurological injury and nonunion. Anterograde nailing can lead to subacromial conflicts. The purpose of this study was to analyze results of an elastic retrograde nailing technique using the Marchetti nail. This method would appear to offer the advantages of closed osteosynthesis without interrupting the rotator cuff. Material and methods Fifty fresh traumatic fractures of the humerus were treated with Marchetti nailing between December 1995 and June 1999. Ten patients had died at last follow-up after having achieved bone healing. Outcome was assessed at a mean 22 months post-surgery for 39 patients. The AO classification and the Hackethal classification modified by De la Caffiniere were used. Outcome was assessed according to the Stewart and Hundley classification. Results Very good outcome was achieved in 13 patients (33%), good outcome in 21 (54%) and poor outcome in 5 (13%). The assembly dismounted in 1 patient who required revision for pin insertion. Two cases of nonulon and two cases with poor function were observed. Mean delay to union was 10 weeks. There were no cases of infection or iatrogenic radial nerve palsy. Secondary fracture at material ablation occured in 2 cases. Discussion and conclusion Closed fixation is an advantage of this method (minimal risk of infection and radial injury). In addition, the rotator cuff is not perturbed. The drawbacks include the risk of secondary fracture, almost exclusively at ablation.