• T Flinkkilä, J Ristiniemi, and M Hämäläinen.
• Department of Surgery, Division of Orthopaedic and Trauma Surgery, University Hospital, Oulu, Finland. Tapio.Flinkkila@oulu.fi
• J Trauma. 2001 Mar 1; 50 (3): 540544540-4.

ObjectiveTo assess results of exchange nailing in nonunion after intramedullary (IM) nailing of humeral shaft fractures.MethodsThis was a retrospective study; 24 patients with nonunion after IM nailing of humeral shaft fractures were reviewed. In 13 cases, nonunion was treated using exchange nailing, and 11 patients were treated nonoperatively. Union was assessed from radiographs. Shoulder joint symptoms and function were assessed after a mean 4.7 years' follow-up using Constant-Murley scoring and self-administered questionnaires devised by L'Insalata et al.ResultsSingle or repeated exchange nailing resulted in union in 6 of 13 patients. Shoulder joint function was satisfactory (mean Constant-Murley score of 72) for those patients whose fracture eventually united and poor (mean Constant-Murley score of 39) for those left with nonunion.ConclusionExchange nailing results in a poor union rate in nonunion after IM nailing of humeral shaft fractures. Permanent nonunion of the humeral shaft leaves the patient with severe disability.

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