ARC Journal of Orthopedic Volume 1, Issue 1, 2016, PP 16-22 www.arcjournals.org ©ARC Page | 16 Retrograde Single Elastic Intramedullary Nail in Closed Simple Diaphyseal Humeral Shaft Fractures in Children Mohamed M H El-Sayed MD 1 , Ahmed F. Shams MD 2 , Osama Gamal 3 , Mohamed ElSawy 4 1 Department of Orthopedics & Traumatology, Tanta University 2,3&4 Department of Orthopedics & Traumatology, Menofeya University. Egypt mhosney2012@hotmail.com Humeral shaft fractures in children are very infrequent and only represent 2–5% of all pediatric fractures. They are predominantly seen in children aged less than 3 years or more than 12 years. Fractures of humeral shaft may result due to direct or indirect forces. The most frequent site of the fracture is between the middle and the distal thirds of humerus. Several series of antegrade intramedullary stabilization of humeral fractures (Rush rods and Ender nails) have been reported. In the literature, several complications such as shoulder impingement and adhesive capsulitis have been reported with this technique. In this study, the functional and radiological results of management of closed fractures of the humerus in children using a single retrograde elastic intramedullary nail shall be evaluated. Keywords: Level of Evidence: Case series, level IV 1. INTRODUCTION Fractures of the humeral shaft usually result from a direct force such as; a direct impact, road traffic accidents and/or crush injuries. Indirect forces such as; a fall on the elbow, or an out stretched hand, or even strong muscular contractions can cause these fractures. The most frequent site of the fracture is between the middle and the distal thirds of humerus. [1, 2] The simplest classification of humeral shaft fractures is based on the location of the fracture site in the humeral diaphysis (proximal, middle, and distal), alignment of the fracture fragments, and the appearance of the fracture line. [3] Radial nerve injury is the most common associated injury due to the close proximity of this nerve to the bone, especially in fractures of the middle third. [4, 5] Functional bracing that is frequently indicated for stable fractures with adequate alignment can most often treat diaphyseal fractures of the humerus in children non-operatively. Noncompliance, in addition to limited fracture stabilization, are the main complications encountered with this type of treatment. [2] Children with humeral shaft fractures require operative treatment only frequently, primarily in cases where surgical stabilization of humeral shaft fractured fragments is required, to assist patient mobilization, in poly-trauma patients, for wound care in open fractures, to maintain adequate alignment, and/or in cases with failed conservative measures. [6][7][8] Although rigid plate osteosynthesis is the most widely accepted operative method, it carries many disadvantages including; extensive soft tissue surgical trauma, loss of the fracture hematoma, significant blood loss, increased operative time, prolonged hospitalization period, delayed rehabilitation, and the risk of intra-operative radial nerve injury. In addition, all the patients are subjected to another surgery for plate removal. [9] Several series of antegrade intramedullary stabilization of humeral shaft fractures (Rush rods and Ender nails) have been reported in the literature. Problems of shoulder impingement and adhesive capsulitis of the shoulder were a significant problem in these series, because most of the nails were inserted in an antegrade fashion through a small incision in the rotator cuff. [7][10] Since publication of outcomes of Spanish and Nancy groups in the early 1980s, elastic stable intramedullary nailing (ESIN) has become a well-accepted method of surgical treatment of diaphyseal fractures of long bones in children and adolescents. [4] In the literature, all the published series were performed using 2 elastic intramedullary nails for fixation of diaphyseal fractures of the humerus in children. In most of the studies the nails were