الفهرس 
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Abstract
Interlocking nails have been developed for the humerus after the wide spread enthusiasm for the tibial and femoral nails. These nails are biological means of fixation and mechanically stable, providing the optimum environment for fracture healing.
The material of study was compossed of 40 patient who had humeral shaft fractures treated with a distal threaded intramedullary nail. They were devided into groupI who were managed with ante-grade nailing and group II who were managed with retrograde nailing. The mean age of patients in group I was 37.1 years, in group II was 35.3 and for the whole material was 36 years. There were 17 males and 23 females. The right side was affected in 19 cases and the left side in 21 cases.
Thirty eight patients had closed fractures of the humeral shaft and 2 patients had open fractures (first degree). The commonest mechanism of injury was road traffic accidents in 25 cases (62.5%); the next common mechanism of injury was the direct injury to the limb as street fights or direct blow to the arm with heavy object in 10 cases (25%), and 5 cases (5%) due to indirect injury to the limb as fall on out streached hand.
The level of the fractures was in the middle third in 20 patients (50%), upper third in 10 patients (25%) and distal third in 10 patients (25%). 20 fractures (50%) were simple transverse, eleven patients (22.5%) were oblique, three (7.5%) were spiral and 6 fractures (15%) were comminuted.
Group I: The surgery was performed under general anaesthesia. The nail was inserted in antegrade fashion with one proximal locking screw and without distal locking screw. The distal locking mechanism was achieved via engaging the distal threads of the nail into the distal cancelous bone 1 cm above the olecranon fossa.
Group II: The The nail was inserted in retrograde fashion with one proximal locking screw and without distal locking screw. The distal locking mechanism was achieved via engaging the distal threads of the nail into the cancelous bone 2 cm below the humeral head.
The arm was splinted with U shaped slap post-operatively. According to fracture comminution and fracture stability, the patients were encouraged gradually to start elbow and shoulder exercises.
The final outcome in group I, was excellent in six patients (30%), good in 12 (60%), fair in one patient (5%) and poor in one patient (5%). In group II, it was excellent in five patients (26.6%) and good in eleven (61.1%), fair in one patient (5.6%) and poor in one patient (5.6%).
There was statistically significant relation between the age and the final results, as the younger the patient the more satisfactory were the results. However gender, site and pattern of fracture had no statistically significant effect on thr results.
Non-union occurred in two patients after 6 months; which was treated by augmentation plating and bone grafting.
In group I, eight patients (40%) had full range of shuolder motion and the other 12 patients had variable limitation of motion: 2 patients have limitation of flexion range from (10o >40o) six had limited abduction range from (10o >40o) and five patients had limited external rotation less than 20o.
In group II eight patients (42%) had full rage of elbow motion, three patients (16.6%) had limited flexion less than 20o and six patients (33.3%) had loss of extention between (10o-50o).
Thus, antegrade nailing significantly affected the shoulder range of motion and retrograde nailing significantly affected the elbow motion.
The over all results of using this nail compared favorably with other nailing systems. In addition this nail had more advantages: it had no distal locking screw so it reduced the operative time and also reduced exposure to radiation .The nail was introduced by screwing not by hammering wich produced compression at the fracture site.