PubMed^® Literature Review

Generated by The Literature - Realtime PubMed^® Analysis

Based on the available evidence, the use of cerclage wire with an intramedullary nail in humeral shaft fractures appears to be a safe and effective technique. The studies consistently reported favorable outcomes in terms of fracture healing and reduction.

Salvador et al. (2019) reported a high rate of fracture healing (94.6%) and a low rate of non-union (3.5%) in their cohort of 56 patients treated with cerclage wire and intramedullary nailing. The use of cerclage wires was associated with better bone contact and a lower rate of malunions compared to intramedullary nailing alone [1].

Similarly, von der Helm et al. (2022) found a low non-union rate (2.6%) and no increase in complications such as infections or radial nerve damage in their study of 109 patients treated with intramedullary nail osteosynthesis and cerclage. They concluded that this combined technique reduced the risk of non-union without compromising nerve function [2].

Han et al. (2017) compared the time to bone union between a cable group and a non-cable group in patients with unstable humeral shaft fractures treated with intramedullary nails. They found no significant difference in the time to bone union between the two groups and concluded that the use of cerclage cables did not delay healing or increase the rate of complications [3].

Regarding pediatric fractures, Daag Jacobsen et al. (2022) reported that most proximal and diaphyseal humeral fractures were treated non-surgically. However, when surgical treatment was required, the most common methods included cerclage fixation with intramedullary nailing. The study highlighted the need for further research on preventive measures for these fractures, but overall, the majority of fractures healed without complications [4].

Regarding the risk of radial nerve damage, von der Helm et al. (2022) found that the rate of iatrogenic radial nerve lesions with additive and limited invasive cerclage was 3.9%. They concluded that there was no increased risk of radial nerve injury when using cerclage in humeral shaft fractures [5].

Conclusion:

In conclusion, the available evidence supports the use of cerclage wire with an intramedullary nail in humeral shaft fractures as a safe and effective technique. This combined approach improves fracture reduction, enhances bone contact, and reduces the risk of non-union compared to intramedullary nailing alone. The technique does not significantly delay the time to bone union and does not increase the rate of complications such as infections or radial nerve damage. However, further research is needed, especially regarding preventive measures for pediatric fractures. Overall, the use of cerclage wire with an intramedullary nail is a valuable option for the surgical treatment of humeral shaft fractures.