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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2001 August-October;52(4-5):195-200
Treatment of proximal metadiaphyseal humeral fractures with Marchetti-Vincenzi intramedullar elastic nail
Bonaspetti G., Fenu R., Bono S., Veneziani S., Pazzaglia U. E.
Background. A standard treatment for humeral complex fractures has not been foun yet. Treatment with cast, surgical treatment with plates and screws, intramedullary nailing, external fixation have be described but any all them is given results so good to be considered as gold standard.
Methods. One-hundred and twenty-four humeral fractures were treated from 1996 to 2000 at the Orthopedic Department of University of Brescia; 11 of this fractures were treated by Marchetti Vicenzi's nail. The surgical technique described by Marchetti Vicenzi has been used, namely: prone patient and posterior elbow nailing. Because of the poor control of the fractures rotation a thoracobrachial cast was put on the patients for four weeks after surgical treatment. After cast removal reabilitation was started. Stewart, Harding and Andres's score was used in evaluating the results.
Results. The results are: 36.5% very good, 18.1% good, 9.1% fear, 36.3% poor. The complications were: 1 case of nonunion; 2 cases of nail proximal migration, 1 case of radial nerve palsy.
Conclusions. Treatment of proximal humeral complex fractures with Marchetti's nail and thoracobrachial cast for four weeks turn out to be a good compromise in order to reduce bone exposure and to allow early rehabilitation. The poor control of the rotation and nail proximal migration in osteoporotic patients limit its use to selected cases.