Functional and clinical outcomes following antegrade intramedullary nailing of humeral shaft fractures with one versus two distal interlocking screws (HUMMER): a secondary analysis of a multicenter prospective cohort study

Abstract Background The AO foundation recommends two interlocking screws at each side of a humeral shaft fracture for antegrade intramedullary nailing (IMN). This study aimed to compare functional and clinical outcomes for one versus two distal interlocking screws in adults with an AO-12A or AO-12B fracture treated with an antegrade IMN. Methods Data of 161 patients with a humeral shaft fracture who participated in a multicenter prospective cohort study (HUMMER) and were treated with an antegrade IMN were used. Functional outcome measures included the Disabilities of the Arm, Shoulder and Elbow (DASH) score, Constant-Murley Score (CMS), and shoulder and elbow range of motion (ROM). Clinical outcome measures were radiologic healing, complications, and surgical reinterventions. Results The IMN had one distal interlocking screw in 71 patients and two screws in 90 patients. Patients with two screws were older (median 61 years; P 25 -P 75 48–70 vs. 54; P 25 -P 75 36–64; p = 0.008), and had comorbidities more often ( n = 56; 62% vs. n = 29; 40%; p = 0.011), Comminuted fractures (AO-type 12B) were more common in the two screws group ( N = 30; 33% vs. N = 16; 23%). In both groups the DASH-score, CMS, and ROM consistently improved over time; no statistically significant differences in functional outcomes and complications were found at any of the follow-up moments. Conclusion The use of one distal locking screw was sufficient in the majority of patients treated with antegrade intramedullary nailing for a humeral shaft fracture. At the operating surgeon’s discretion, in older patients with poor bone quality or increased fracture comminution, two screws were preferred. Level of evidence: III.

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Journal
Langenbeck s Archives of Surgery
Published
2026-10-14
DOI
https://doi.org/10.1007/s00423-026-04336-4
Primary Topic
Bone fractures and treatments
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article
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article

Functional and clinical outcomes following antegrade intramedullary nailing of humeral shaft fractures with one versus two distal interlocking screws (HUMMER): a secondary analysis of a multicenter prospective cohort study

Jelle E. Bousema, Wim Eduard Tuinebreijer, Karel A. Kolkman, Gert R. Roukema et al.
Langenbeck s Archives of Surgery
Bone fractures and treatments
article

Functional and clinical outcomes following antegrade intramedullary nailing of humeral shaft fractures with one versus two distal interlocking screws (HUMMER): a secondary analysis of a multicenter prospective cohort study

Jelle E. Bousema, Wim Eduard Tuinebreijer, Karel A. Kolkman, Gert R. Roukema, Robert Haverlag, Shawn W. O’Driscoll, Hanna C Björnsson, Axel R. Deenik, Hugo W. Bolhuis, M.H.J. Verhofstad, Priscilla A. Jawahier, Edgar J. T. Ten Holder, W. Herbert Roerdink, Richard S. Yoon, Esther M.M. Van Lieshout, Cornelia A. W. Notenboom, Leendert H. T. Nugteren, Maarten van der Elst, Guy Putzeys, Peer van der Zwaal, Hans-Peter W. van Jonbergen, Rudolf Wilhelm Poolman, Yordy Claes, J. Carel Goslings, Marco Waleboer, Robert Jan Derksen, Boudijn S. H. Joling, Wietse P. Zuidema, Saskia H. Van Bergen, Ewan Ritchie, Gijs J. J. Van Aert, William Todd Obremskey, Mathieu M. E. Wijffels, Martin J. Heetveld, Martijn Poeze, Ron Onstenk, Emmelie N. Dekker, Dennis Den Hartog, Ivo Beetz, Tim Van der Torre, Ahmed Al Khanim, Frits M. Van der Linden, Martin G. Eversdijk, Jonathan D. Barlow, Jaap B. Schulte, Nicolaj M. R. Soesman, M.W.G.A. Bronkhorst, Peter A. Leenhouts, Boyd C. P. Van der Schaaf, Michael David McKee, Philippe Wittich, J. Daniël Cnossen, Kiran C. Mahabier, Lars Adolfsson, Niels W. L. Schep, Jan Bernard Sintenie, Aron J. M. De Zwart, Nina Theyskens, Peter Vasilios Giannoudis, Milko M. M. Bruijninckx, HUMMER Investigators, Egbert J. M. M. Verleisdonk, Jos P. A. M. Vroemen, Bas J. Punt, Frank H. W. M. van der Heijden, Sven A.G. Meylaerts, Albert J.H. Kerver, Jeroen de Haan, Héctor J. Aguado, Martin Jaeger, Pieter Koen Bos, HUMMER Expert panel, Jan P. Van Van Dijk, Kevin Cheng, P. Ted Den Hoed
article en

Abstract

Abstract Background The AO foundation recommends two interlocking screws at each side of a humeral shaft fracture for antegrade intramedullary nailing (IMN). This study aimed to compare functional and clinical outcomes for one versus two distal interlocking screws in adults with an AO-12A or AO-12B fracture treated with an antegrade IMN. Methods Data of 161 patients with a humeral shaft fracture who participated in a multicenter prospective cohort study (HUMMER) and were treated with an antegrade IMN were used. Functional outcome measures included the Disabilities of the Arm, Shoulder and Elbow (DASH) score, Constant-Murley Score (CMS), and shoulder and elbow range of motion (ROM). Clinical outcome measures were radiologic healing, complications, and surgical reinterventions. Results The IMN had one distal interlocking screw in 71 patients and two screws in 90 patients. Patients with two screws were older (median 61 years; P 25 -P 75 48–70 vs. 54; P 25 -P 75 36–64; p = 0.008), and had comorbidities more often ( n = 56; 62% vs. n = 29; 40%; p = 0.011), Comminuted fractures (AO-type 12B) were more common in the two screws group ( N = 30; 33% vs. N = 16; 23%). In both groups the DASH-score, CMS, and ROM consistently improved over time; no statistically significant differences in functional outcomes and complications were found at any of the follow-up moments. Conclusion The use of one distal locking screw was sufficient in the majority of patients treated with antegrade intramedullary nailing for a humeral shaft fracture. At the operating surgeon’s discretion, in older patients with poor bone quality or increased fracture comminution, two screws were preferred. Level of evidence: III.

Langenbeck s Archives of Surgery
Linköping University (SE), Mayo Clinic (US), AZ Groeninge (BE), University Medical Center Freiburg (DE), Erasmus MC (NL), Maasstad Ziekenhuis (NL), Elkerliek Ziekenhuis (NL), New York University Langone Orthopedic Hospital (US), University of Arizona College of Medicine- Phoenix (US), New York University (US)
Good health and well-being
Openalex Percentile: Top 12%
Bone fractures and treatments
DOIOpen Access PDFOpenAlex
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