Plate and locked intramedullary nailing for humeral fractures are golden standard procedure, but the humerus is a non-weight bearing bone and can tolerate a larger range of acceptable alignment. We believe the ESINs can provide enough relative stability for humeral shaft fractures in certain adult patients.
There were four new indications for using ESINs: 1) Patient could not tolerate a sugar-tong splint but was a high-risk for general anesthesia, 2) intra-medullary canal narrowing (< 7 mm), 3) long spiral or oblique fracture over the meta-diaphyseal junction, and 4) obesity in this study. All patients received retrograde fixation with 2 TENs, except for 1 patients with a long spiral fracture over the proximal meta-diaphysis. Patients was routine follow-up plain radiographs until bone union and were evaluated functional results by Mayo Elbow Performance Score (MEPS), and Quick DASH score at the last outpatient clinic visit.
A total of 16 patients with a mean age 54.4 years were included. The mean follow-up time was 14 ± 2.5 months, and the average time to bone union was 16 ± 4.3 weeks. There were no wound infections, loss of reduction, fracture nonunion, implant failure, or skin irritation expect for 1 nail back-out because of osteoporosis.
We have reported good results using ESINs for the displaced fractures of the humerus in the four indication adults who would not be able to tolerate plate fixation or intra-medullary nailing. The ESNIs fixation method is a simple procedure that provides a small incision, minimal blood loss, short surgical time, and relative stability fixation.

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