Fractures of the shaft of the humerus account for approximately 3–5% of all fractures and represent an important cause of morbidity affecting upper limb function¹. These injuries commonly occur due to high-energy trauma in younger individuals and low-energy falls in elderly populations². Proper restoration of alignment, rotation, and length is essential to ensure optimal functional recovery³. While conservative management remains an option, surgical fixation is increasingly preferred due to faster rehabilitation and reduced complications⁴. Plate osteosynthesis provides rigid fixation but requires extensive soft tissue dissection and carries risks such as infection and radial nerve injury⁵. Intramedullary interlocking nailing offers a minimally invasive alternative with preservation of fracture biology and early mobilization⁶. McCormack et al (7). demonstrated comparable outcomes between plating and nailing⁷, while Chapman et al (8). highlighted concerns regarding shoulder function⁸. Recent advances in nail design have reduced these complications and improved outcomes⁹. Studies by Hameed et al. and Furuhata et al. have shown favorable functional outcomes with intramedullary nailing¹⁰,¹¹, although variability persists in reported results. Therefore, further prospective evaluation is necessary to assess functional and radiological outcomes in selected fracture patterns.

AIM

To evaluate functional outcome, radiological union, and postoperative complications of intramedullary interlocking nailing in humeral shaft fractures.

METHODOLOGY

This prospective interventional study was conducted over 18 months including 35 patients with humeral shaft fractures treated with intramedullary interlocking nail fixation. Patients above 18 years with AO type 12A1, 12A2, 12A3, 12B1, and 12B2 fractures were included, while pathological fractures, open fractures, and neurovascular injuries were excluded. All patients underwent clinical and radiological evaluation followed by surgical fixation under C-arm guidance. Postoperative rehabilitation included early mobilization and structured follow-up at regular intervals. Functional outcomes were assessed using Neer’s Shoulder Score and radiological union was evaluated using serial radiographs. Statistical analysis was performed using SPSS with p < 0.05 considered p < 0.05 was considered statistically  significant .

RESULTS

Table 1: Functional Outcome (Neer Score Distribution)

Table 2: Time to Radiological Union

Table 3: Postoperative Complications

RESULTS

The study included 35 patients with humeral shaft fractures treated using intramedullary interlocking nailing. Functional outcome assessed by Neer’s score showed satisfactory results in 27 patients (77.14%) and excellent results in 7 patients (20.00%), while only 1 patient (2.86%) had an unsatisfactory outcome. Radiological union was achieved in the majority of cases within 12–16 weeks in 16 patients (45.71%), followed by ≤12 weeks in 13 patients (37.14%), and >16 weeks in 6 patients (17.14%). Postoperative complications were minimal, with delayed union observed in 4 patients (11.43%), shoulder stiffness in 3 patients (8.57%), and non-union and malunion each in 2 patients (5.71%). A majority of patients (68.57%) had no complications.

DISCUSSION

The present study demonstrates that intramedullary interlocking nailing provides favorable functional and radiological outcomes in humeral shaft fractures. Court-Brown et al. described the epidemiological significance of humeral fractures, consistent with the demographic distribution observed in this study¹. Ekholm et al. emphasized the importance of operative stabilization for improved outcomes³. McCormack et al. reported comparable union rates between plating and nailing⁷, aligning with the satisfactory union rates observed. Chapman et al. noted shoulder-related complications following nailing⁸, whereas improvements in surgical techniques have reduced such issues, reflected in the low incidence of stiffness in this study. Lin reported satisfactory outcomes with interlocking nails⁶, which is comparable to the high percentage of satisfactory results observed. Hameed et al. demonstrated good functional recovery with intramedullary nailing¹⁰, similar to the progressive improvement in Neer scores noted here. Furuhata et al. identified factors influencing shoulder outcomes¹¹, reinforcing the importance of early mobilization. Angachekar et al. and Alrashedan et al. showed comparable outcomes between plating and nailing with advantages of minimally invasive techniques¹²,¹³. Lakhani reported high union rates with interlocking nails¹⁴, which is consistent with the radiological outcomes observed. Bal et al. highlighted acceptable complication rates with nailing¹⁵, aligning with the low complication rates in this study. Overall, the findings of the present study are consistent with McCormack et al. and Hameed et al., supporting intramedullary interlocking nailing as an effective treatment modality.”

CONCLUSION

Intramedullary interlocking nailing is a reliable and effective modality for the management of humeral shaft fractures, providing excellent functional outcomes, timely radiological union, and minimal complication rates.

Its minimally invasive nature, preservation of fracture biology, and facilitation of early mobilization make it a preferred surgical option, particularly in selected fracture patterns, thereby improving overall patient recovery and quality of life.

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