[Antegrade or retrograde intramedullary nailing in diaphyseal or sub-capital humeral fractures in the adult].

The aim of this retrospective study was the evaluation of three current medullary nailing techniques and their approach related problems in diaphyseal and proximal humeral fractures. 28 patients (15 female, mean age 65 y; 13 male, mean age 53 y) with either diaphyseal (n = 22) or proximal humeral (n = 6) fractures treated with different nailing systems were reviewed (mean follow up 18.3 months). Two main groups were formed according to the surgical approach: an anterograde nailing group (AN), stabilized with Seidel (Howmedica) nails (n = 12) versus a retrograde nailing group (RN) with either Prévot (Landos) nails (n = 7) or Hackethal (Ulrich) nails (n = 9). The two groups were comparable regarding to age, follow up and fracture type. The subjective scores (global function, all day activity, pain, ROM) of the two groups (AN and RN) showed no statistically significant differences. Subacromial impingement led to reoperation in 50% (6/12) of the AN patients (Seidel nail). In 3/16 patients a reoperation was necessary due to secondary proximal or distal nail migration (Hackethal or Prévot nails). Delayed union was found either in one. Seidel or one Prévot nailed humerus. No postoperative infections or neurological problems (3 preoperative radial palsies recovered) due to the operative pro cedure were seen. The AN related subacromial impingement seems to be more disabling than RN related reduction of elbow function (extension deficit).