The functional outcomes of intramedullary nails used in humeral shaft fractures in two urban public health facilities in South Africa

Abstract

Introduction Humeral fractures account for nearly 3% of all recorded fractures. South Africa faces an array of societal challenges, including one of the highest rates of motor vehicle accidents (MVAs) globally, which are considered a significant contributing factor to humeral fractures. The management of these fractures has undergone significant evolution over the years, with various treatment methods becoming available, primarily involving plate osteosynthesis or intramedullary nailing (IMN). However, the associated complications of humeral shaft nails, such as rotator cuff injuries, have prompted surgeons to explore alternative treatment methods to mitigate these risks. Subsequent refinements in surgical techniques have reduced these risks over time, allowing plate humeral IMNs and osteosynthesis to be used interchangeably based on surgeon preference and expertise. This study aims to quantitatively assess the functional outcomes of surgically managed humeral shaft fractures using IMNs. Methodology The study focuses on the functional outcomes of humeral shaft fractures surgically managed with IMNs. A retrospective cohort study with prospective recall was conducted on patients who underwent surgical fixation for humeral shaft fractures that met the inclusion criteria over a four-year period (2019 – 2023). The study assessed patient demographics, time to return to work, post-surgical pain, patient satisfaction, and functional outcome using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) scores. Results Out of 122 identified patients, 45 were included in the study. Surgeries were primarily performed by registrars and occasionally by medical officers in two facilities. There was a predominance of males, with the majority being right-handed and over 80% sustaining injuries in that group. Injuries were mostly sustained from Motor Vehicle Accidents (MVAs) and Pedestrian Vehicle Accidents (PVAs). On average, return to Activities of Daily Living (ADLs) was approximately 5 weeks, and of the over 70% of employed patients, over 80% were able to return to work in a mean time of seven weeks. Visual Analog Scale (VAS) scores averaged two on the 100-mm VAS scale. Quick DASH scores for 44 of the 45 recorded cases were all below 29, with patients averaging around seven out of 100. Patients reported an overall satisfaction level between good and very good, and only the mechanism of injury and analgesia use had a significant impact on these results. vii Discussion The average age recorded was 35 years, with the majority being employed men. Comparable return-to-work times, coupled with low VAS scores, indicated that working-class patients were able to resume everyday activities, including forms of employment. One patient reported having to change employment due to an inability to carry out heavy-duty activities, while the remainder returned to their previous jobs. Patient demographics, barring sex, showed insignificant differences for return-to-work times or VAS scores. Females were noted to take slightly longer to return to ADLs but not to return to work. Conclusion The use of IMN has frequently been linked to post-surgical shoulder impingement and our study showed that this is not as high as what was previously expected in literature. Humeral nail fixation shows benefit in allowing patients earlier function of their affected limb with little influences from their age, hand dominance and employment type.