الفهرس 
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Abstract
Humeral shaft fractures comprise approximately 2.5% of all traumatic fractures in children. They are the second to the clavicle in birth fracture incidence.
Fractures of humeral shaft result from direct force during a direct impact, traffic accidents or crush injuries. Indirect forces such as fall on elbow or extended arm or strong muscular contractions can result in a fractured humerus. The most frequent site of the fracture is between the middle and the distal third of humerus.
For paediatric humeral shaft fractures, conservative and surgical treatment options are available. If fractures are unable to be reduced adequately or maintained in adequate alignment by conservative treatment, these should also be treated surgically. Titanium flexible nails are the preferred implant.
Children with traumatic humeral shaft fractures require operative treatment to assist with patient mobilization, wound care or the maintenance of adequate alignment.
Comparison between using of single flexible intramedullary nail (titanium type of Nancy group) and using of double nails for fixation of paediatric humeral shaft fractures in children between six and sixteen years was evaluated in this study.
Thirty paediatric patients ranging in age from 6 to 16 years (22 males and 8 females) were included in this study. Fifteen patients treated surgically using a retrograde single elastic intramedullary nail (group I) and other fifteen patients (group II) treated by retrograde double flexible nails (lateral dual entry).
The studied patients were distributed on both maneuvers on alternative base. Relative surgical indications included open fractures, inability to maintain an acceptable reduction, concomitant lower extremity fractures and closed head injury.
The studied patients were those attending in Menofia University Hospitals and Menouf General Hospital.
Clinical and radiological follow up for all cases were scheduled at 2 weeks, 4 weeks, 8 weeks, 16 weeks and 24 weeks postoperatively till union. AP and lateral views showing the shoulder, entire humerus and elbow were done. Follow up is important with an x-ray every 2 weeks to ensure adequate maintenance of position. Healing generally depending on the age of the child.
One patient in (group I) showed 10° varus that was accepted and remodeling occurred later at final follow up. Another patient showed rotation of the distal fragment about 15° as the fracture was spirally shaped and distally located but clinically the patient had full range of motion of the nearby joints. Two patients in (group II) had a preoperative radial nerve injury, (neuropraxia) that recovered spontaneously within 4 months. One patient in (group I) had preoperative radial nerve injury, (neuropraxia) that recovered spontaneously within 3 months. Proximal migration occurred in one patient of (group I) and protrusion of the nail from lateral cortex occurred in one patient of (group II). Nail entry irritation occurred in one patient of (group II) that was treated by early removal of the nail when radiological union was achieved.
Long term results were evaluated according to clinical and radiological criteria of Qidwai. The DASH score for the evaluation of shoulder function and disability. The functional outcome was compared with the healthy side.
All the patients were followed for a mean of 5.33 months, with a range from 4 to 6 months. Radiographically, union started in (group I) treated by single nail and (group II) treated by double nails with the same mean which was 4,47 (range from 3 to 6 weeks). Operative time increased with fixation by double flexible nails. Two patients in (group I) developed superficial wound infections postoperatively and one patient in (group II) with superficial wound infection.
The mean operative time (insertion) on the (group I) was 25.33 (range15-45) minutes. The mean operative time (insertion) in the (group II) was 37.67 minutes (range 30-45) minutes. This demonstrates that there was highly significant statistical difference p-value =0,001 between studied groups regarding operation time (minutes).
The results in (group I) were excellent in 13 patients (86, 7%) and good in 2 patients (13, 3%). In (group II) results were excellent in 14 patients (93, 3%) and good in 1 patient (6, 7%).
Excellent cases with full range of motion of nearby joints, stiffness less than 100, no postoperative infection and all cases healed without delayed union. Good cases with satisfactory function, stiffness of nearby joints less than 200 and postoperative superficial infection. There was no significant difference between our both groups according to end results.