Background: As primary Total Hip Arthroplasty (THA) is increasingly performed in younger, more active patients, revision procedures have become more frequent and technically demanding. The choice between cementless and cemented femoral fixation in revision THA remains controversial, with each approach offering distinct biological and mechanical advantages. Objective: To synthesise current biological principles and clinical evidence comparing cemented and cementless femoral fixation in revision THA, with particular attention to complications, fixation strategies, and applicability in Lowand Middle-Income Countries (LMICs). Data source: A narrative review of contemporary orthopaedic literature, including national joint registry data, systematic reviews, and key clinical studies evaluating femoral fixation methods in revision THA. Data selection and extraction: Relevant studies were identified based on clinical relevance to revision THA, fixation method, patient age, bone quality, infection status, and reported outcomes. Data were qualitatively synthesised with emphasis on survivorship, complications, and functional outcomes. Results: Cementless stems provide biological durability through osseointegration, while cemented stems offer immediate mechanical stability and are particularly advantageous in osteoporotic bone or in infected cases when antibiotic-loaded cement is utilised. Registry data demonstrate a clear age-related shift, with cementless fixation predominating in patients younger than 75 years and cemented fixation remaining preferred in older patients. Long-term methods: survivorship is comparable between fixation methods; however, cementless stems are associated with higher risks of periprosthetic fracture and early subsidence. Functional outcomes are equivalent in most cohorts. Challenges specific to LMICs, including implant availability, cost constraints, and variable bone quality, influence fixation strategy selection. Conclusions: No single fixation strategy is universally superior in revision THA. Patient-specific selection guided by age, bone stock, and infection status remains paramount. Emerging advances in biologics, nanotechnology, additive manufacturing, and artificial intelligence hold promise for further refinement of fixation strategies and outcomes in revision hip arthroplasty.
Background: Lower Back Pain (LBP) is a common health condition affecting a large portion of the world population, often leading to considerable disability and significant healthcare costs, particularly in low-resource settings like Tanzania. Various factors have been implicated such as socio-demographic, occupation and lifestyle related. Previously, LBP was seen in the elderly; however, there is a significant rise in the number of patients in the working age group which resulted in functional disability and reduction of productivity necessitating the need for early interventions. Objective: We aimed at studying the epidemiology of lower back pain among patients attending physiotherapy sessions at Muhimbili Orthopaedic Institute (MOI), Tanzania. To investigate the sociodemographic factors; disease duration, severity and level of disability; and factors associated with functional disability due to low back pain among patients attending physiotherapy sessions at MOI, Tanzania. Methods: A hospital based descriptive cross-sectional study was conducted among patients with lower back pain attending physiotherapy sessions at MOI. A Swahili version structured questionnaire was used to collect data on social demographic characteristics, duration of pain, pain severity and functional disability using Oswestry Disability Index (ODI) Score by convenient sampling method. Results: Two hundred and twelve participants were enrolled with the mean age of 52.67± 13.69 years, with the majority of them (50.9%) between the ages of 40-60 years. Females comprised 70.3% of the participants and 59.4% of them reported prolonged sitting (>4 hours) at work. Chronic LBP was reported in 95.8% of participants, most of which had moderate pain level (53.3%). Based on the Oswestry Disability Index, 48.1% had mild disability, 39.6% moderate, 7.1% severe, and 5.2% had no disability. Significant factors associated with disability included prolonged driving (AOR=3.592, 95% CI: 1.171–10.875, p=0.025), lifting heavy objects (AOR=0.502, 95% CI: 0.255–0.994, p =0.046), employed (AOR = 3.096, 95% CI: 1.354–7.148, p = 0.007), marital status (married/cohabiting) (AOR = 0.392, 95% CI: 0.210–0.738, p = 0.021) and educational level (AOR=45.33 for no schooling, 95% CI: 3.563–574.650, p=0.003). Conclusion: There were a significant number of patients with chronic low back pain in our setting most of which were associated with prolonged sitting, heavy lifting, being employed, married or cohabiting and low education as predictors of functional disability among them. These findings highlight the need for targeted occupational and educational interventions to mitigate disability risks.
Background: The glenoid bare spot has been proposed as a central landmark for arthroscopic quantification of glenoid bone loss in shoulder instability, but some studies have questioned its consistency and centrality. No cadaveric data exist from the local Kenyan population. Objective: To describe the presence, morphology, and location of the glenoid bare spot in a Kenyan cadaveric sample and assess its reliability as a geometric center. Methods: Fifteen formalin-fixed shoulders (7 right, 8 left) from 10 adult cadavers were dissected. Shoulders with damage or degeneration were excluded. Bare spot presence, shape, and diameter were recorded. Distances from the bare spot center to anterior and posterior glenoid rims were measured. Descriptive statistics were applied. Results: The bare spot was present in all 15 specimens. Shapes were oval (40%), circular (33%), irregular (13%), and crescentic (13%), with median diameter 4.87mm (range 2.34–14.56mm). Mean distance to anterior rim was 7.33mm (range 3.99–9.58 mm); to posterior rim, 9.23mm (range 3.97–17.02mm), indicating anterior eccentricity. Conclusion: In this cadaveric cohort, the glenoid bare spot was universally present but variable in size/shape and consistently anteriorly eccentric. These findings support existing evidence that it is not a reliable central landmark for assessing glenoid bone loss, with potential to overestimate anterior defects if used arthroscopically.
Background: Knowledge of trauma and orthopaedic surgery is a key component in the practice of medicine in Kenya, with an increase in morbidity and mortality from road traffic accidents. Medical officers play a fundamental role in the initial management of these fractures, underscoring the need to assess medical students’ competency. Lower practical skill acquisition noted in undergraduate students points out how musculoskeletal conditions may be handled subpar by physicians, and the study suggests possible remedies for future undergraduate training. Objective: To determine the level of knowledge and competency and association between the two in orthopaedic training among undergraduate medical students at the Faculty of Health Sciences, University of Nairobi, Kenya. Methods: This was a cross sectional study. The study recruited 237 out of 440 level six medical students who had finished their orthopaedic surgery rotations at the University of Nairobi. Consecutive sampling technique was utilized. Data collection was done using a structured questionnaire, which included the Friedman and Bernstein musculoskeletal competence test. Descriptive statistics were used to analyse the characteristics of participants. Binary logistic regression was used to investigate the factors associated with competency among level six medical students. Results: Students who had adequate knowledge in orthopaedic training were 25 (10.5%). Some 33% of the students were willing and interested in pursuing further orthopaedic training. Using the Friedmann and Bernstein competency examination tool, the results showed a mean score of 47.5% (SD ± 26.2). The competency cut-off was set at 73.1%, and only 11.8% of the respondents scored above this threshold. Respondents who had adequate knowledge of orthopaedic surgery training were found to be 2.7 times more likely to have high competency compared to those with inadequate knowledge, Odds Ratio (OR) = 2.73, 95% Confidence Interval (CI): 1.99 – 7.55, p =0.005. Conclusion and recommendations: The levels of both knowledge and competency were low in level six undergraduate orthopaedic surgery training, highlighting a major gap. Adequacy of knowledge was more likely to improve competency. Thus, there is need to revise the curriculum to include more comprehensive and structured orthopaedic modules, to have more confidence in basic practical skills.
Background: In South African local language, illegal artisanal gold miners are called “zama-zamas”, a slang word for “hustlers”. There is paucity of orthopaedic literature evaluating orthopaedic injuries associated with this sector of mining. Objective: The aim of our study is to evaluate orthopaedic injuries associated with artisanal mining and the factors that influence them. Methods: We undertook a retrospective study evaluating medical records and radiological images of patients treated for orthopaedic trauma injuries between January 2024 and April 2025. We evaluated patient demographic data, nature of injury, Mechanism of Injury (MOI), treatment instituted and nationality. Results: The study population included 23 patients, 22 (95.6%) males and 1 (4.3%) female all of whom were black Africans. The mean age was 28.9 years old (19 - 41). Two (9%) of the patients were South Africans, 65% foreign nationals and 26% did not disclose. Seventeen (63%) of the injuries were to the lower limb while 14.8% were to the upper limb. One patient had a fracture-dislocation of the spine and we recorded three complex pelvic injuries. The most common mechanism of injury were rock falls (n=12) followed by gunshots (n=5). Two injuries were falls from height and one was from assault. Three patients had an unknown mechanism of injury. Majority of patients (61%) were treated surgically with two needing transfer to a tertiary centre. Conclusion: Illegal gold mining is a cause of high energy orthopaedic trauma predominantly in male foreign nationals. Majority of these injuries require surgery and a long hospital stay.
Background: Metatarsal fractures are common orthopaedic injuries, constituting up to 35% of all foot fractures. Intramedullary K-wire osteosynthesis is frequently used for their management. Despite its widespread use, functional outcomes following this treatment remain underexplored in our setting. Objective: To determine the short-term functional outcomes of patients with metatarsal fractures after intramedullary K-wire osteosynthesis at Muhimbili Orthopaedic Institute (MOI). Methods: This was a prospective cohort study conducted at MOI. Patients aged 18 years and above with AO/ICI Type A metatarsal fractures treated with K-wire osteosynthesis were enrolled. Functional outcomes were assessed using the Maryland Foot Score at 12 weeks postoperatively. Statistical analysis was performed using STATA 17, with a significance level set at p<0.05. Results: A total of 33 patients were included. The mean age was 30 ± 11.71 years, with 90% being male. Over half (57.58%) achieved good functional outcomes, while 3.03% experienced treatment failure. Pain levels were minimal in 75.75% of participants, and 70% demonstrated good mobility. No statistically significant associations were found between functional outcomes and independent variables. Conclusion and Recommendations: Intramedullary K-wire osteosynthesis for metatarsal fractures results in favorable short-term functional outcomes. However, further multicenter studies with larger sample sizes and longer follow-up periods are recommended to assess long-term recovery trends.
Background: Literature has not reached consensus on a suitable approach for the management of midshaft clavicle fractures in adults, even though recent multicentre, randomised, controlled trials have shown superior functional results following operative intervention. Local literature on this topic is sparse. Objective: The aim of this study was to compare the functional results of operatively and nonoperatively treated patients with midshaft clavicle fractures in the South African context. Methods: We conducted a prospective review of 54 patients, aged more than 18 years, who were managed at a single tertiary centre in Johannesburg, South Africa between 2017 and 2023. Outcome analyses included a file audit, the American Shoulder and Elbow Society scoring tool via a telephonic questionnaire, and photographic evaluation of shoulder abduction and flexion. Results: Overall, 21 of 54 patients (39%) were operatively treated with plate osteosynthesis and 33 of 54 patients (61%) were non-operatively treated with a sling for 6 weeks. There were no statistical differences in demographics, occupation, and dominant side injuries between the groups. More patients in the operative group reported being satisfied with the result (16 of 21; 76%) compared to the non-operative group (17 of 33; 52.5%; Odds Ratio [OR] 3.78). The operative group also showed a superior mean patient reported functional score of 86.2 (Interquartile rage [IQR] 70 to 100; Standard Deviation [SD] 16.5) versus 76.6 (IQR 53 to 99; SD 22; p = 0.124) in the non-operative group. The OR for having significant chronic shoulder pain following non-operative treatment was 2.61. There were no differences in the mean measured shoulder abduction for the operative group (160°; IQR 145 to 180°) compared with the non-operative group (160°; IQR 135 to 180°; p = 0.735). The complication rates between the operative and non-operative groups were also similar (19% vs 15%, respectively; p = 0.279). Conclusion: Operative treatment of patients with midshaft fractures yields superior pain scores, less chronic shoulder pain, and a higher likelihood of patient satisfaction compared with non-operatively treated patients. This study proposes operative management of midshaft clavicle fractures in the South African context.
Background: Medial malleolar fractures are frequently encountered in ankle injuries and require internal fixation to restore stability and enable early mobilization. Traditionally, partially-threaded screws have been the preferred fixation method. However, concerns about their biomechanical limitations, including lower pullout strength and inadequate fracture compression exist.Objective: This systematic review and meta-analysis aimed to compare clinical outcomes betweenfully-threaded and partially-threaded screws in medial malleolus fracture fixation.Methods: A systematic search of PubMed, MEDLINE, and CINAHL databases was conducted following PRISMA guidelines. Comparative studies evaluating fixation with fully versus partially-threaded screws were included. Data on delayed/nonunion, implant-related reoperation, and infection rates were extracted and analyzed using a random-effects meta-analysis model.Results: Six studies comprising 432 patients met the inclusion criteria. Among the 346 patients analyzed, fixation with fully-threaded screws was associated with a significantly lower rate of implant-related reoperations compared to partially-threaded screws (RR: 0.18, 95% CI: 0.05–0.60). Infection rates were comparable between the two groups (RR: 1.02, 95% CI: 0.25–4.06).Conclusion: Fully-threaded screws appear to reduce the need for implant-related reoperations compared to partially-threaded screws in medial malleolar fracture fixation.
Congenital knee dislocation is a hyperextension deformity of the knee with anterior tibia displacement present at birth. It is a rare condition that occurs at 1 case per 100,000. It is sometimes associated with other musculoskeletal congenital malformation. It is a result of abnormal fetal development during pregnancy, leading to ligamentous laxity and joint instability. Congenital knee dislocation is usually diagnosed at birth or shortly after. It is mainly a clinical diagnosis. If diagnosed early and appropriate treatment is given the children attain normal gait and functionality. When it is associated with other musculoskeletal congenital malformations such as arthrogryposis and hip dislocations, treatment becomes difficult hence the outcome may not be satisfactory.
Background: Depressive disorders are the second most common mental health condition and affects approximately 4.5% of the global population. Chronic pain associated with osteoarthritis (OA) limits function and negatively impacts quality of life consequently worsening depressive symptoms. OA patients with comorbid depression for THA have lower functional scores than non-depressedpatients at baseline and follow-up assessments. The compounded effect of an aging population coupled with under-resourced mental health services in a low- and medium-income country results in underdiagnosis and undertreatment of mental health disorders. Objective: This study aims to investigate the incidence of depression peri-operatively and the impact of depression on outcomes in end-stage osteoarthritis patients for Total Hip Arthroplasty (THA) in sub-Saharan Africa. Methods: Depressive symptoms were assessed using two self-administered questionnaires-Zung Self-Rating Depression Scale (SDS) and the Patient Health Questionnaire-9 (PHQ-9). Results: There were 150 patients (mean age, 60.1 years; 68.7% female) undergoing THA. Preoperatively 48.7% were depressed and 51.3% non-depressed. Non-depressed had greater baseline Harris Hip Scores (HHS) than depressed (p=0.025). After mean follow-up of 21.3 months 11.4% remained depressed and 36.9% improved to being non-depressed. Both cohorts improved HHS postoperatively(p<0.001). Conclusion: This study suggests that even in resource poor low-, middle-income countries-such as South Africa, patients who present for THA with depressive symptoms achieve significant gains in both physical and mental health.
Background: The Phrenic Nerve (PN), essential for diaphragm movement and respiration, mainly arises from C3–C5 spinal nerves, predominantly C4.Objective: To examine variations in PN roots and terminal branches.Methods: Twenty hemi-sections dissected from 10 human donors, identifying and painting the PN and its roots. Among 20 hemi-sections, 4 PN were further studied in the chest to observe terminal branch variations.Results: This study examined variations in the origins and terminal branching (Tb) of the PN across 20 hemi-sections. PN roots were identified in 100% of cases, with origins varying: 5% from C1–3, 10% from C2–3, 5% from C2–4, 25% from C3, 5% from C3–4, 5% uniquely from C3 and C5, 20% from C4, and 25% from C4–5 with an anastomotic branch to the dorsal scapular nerve from PN. Regarding terminal branching, 50% showed 2 ± 1 branches (right side), 25% showed 4 ± 1 (left), and 25% showed 3 ± 1 (left), indicating notable variability in PN anatomy.Conclusions: Awareness of PN variations among the roots formation and its terminal branching is critical for enhancing safety and successful surgical and anaesthetic procedures around the area.
Background: In the healthcare setting, much focus is directed at preventing bloodborne illness transmission by needlestick, but, despite the well-documented risk of disease transmission across mucous membranes, precautions against blood splashes to the eye are often not practiced. The risk of blood splash to the eye is especially high in orthopaedic procedures where the use of power tools can cause aerosolization and high velocity spray of contaminated fluids.Objective: This study aimed to evaluate the risk of conjunctival contamination from blood and bodily fluid splash and the practice of using protective eyewear among theatre staff during intramedullary nailing for the treatment of long bone fractures at Muhimbili Orthopaedic Institute (MOI).Methods: A hospital-based cross-sectional study was carried out at Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania to determine the rate of conjunctival contamination during intramedullary nailing procedures. Protective goggles were provided to surgical staff during intramedullary nailing procedures and, after surgery, inspected for macroscopic splashes. The questionnaire was used to collect information about utilization of protective eyewear by surgical staff.Results: Of the 491 goggles assessed, 92.46% were found to have evidence of macroscopic blood splash. The incidence of blood splashes during the operations was statistically significant (p < 0.001) at 89.06%- 94.11% C.I. of the 56 surgical staff included, 28.6% and 71.4% reported never or irregularly wearing protective eyewear, respectively.Conclusion: Nine in every ten goggles were found to have blood splashes and the use of eye protective devices was low and inconsistent among surgical staff. This carries with it, the risk for transmission of blood borne pathogen such as HIV and Hepatitis B and C.
Background: Surgical Site Infection (SSI) is one of the negative outcomes of any orthopaedic procedure. Infection leads to devastating morbidity, mortality and increased resource utilization. Objectives: This study was to assess the burden and risk factors associated with SSI post acetabular reconstruction in our establishment. The study also determined the proportion and risk factors of SSI post acetabular reconstruction at Muhimbili Orthopaedic Institute (MOI). Methods: This was a descriptive prospective hospital-based study which included all patients who had undergone acetabular reconstruction surgery during the study period. Structured questionnaire was used to collect data. Variables were analyzed using SPSS version 23. Results: A total of 37 patients were included in this study and the proportion of SSI was found to be 10.8%. Staphylococcus aureus and Klebsiella pneumonia were isolated in 75% and 25% of these patients respectively. Conclusion: Burden of SSI is relatively high among patients undergoing acetabular reconstruction surgeries at MOI. Both gram positive and negative organisms were implicated in SSI.
Background: Traumatic knee joint injuries are among the leading causes of disability in the world. The diagnosis of these injuries, however, varies across different modalities, with clinical assessments by experienced professionals occasionally yielding superior findings compared to radiology. Establishing a definitive diagnosis is imperative for timely and effective management of knee injuries, which is essential for optimizing patient outcomes. Objective: The aim of this study was to compare the diagnostic accuracy of clinical and radiological tests, in reference to arthroscopic findings, in diagnosing knee joint injuries. Design: This was a multi-center prospective cross-sectional study conducted at four selected hospitals in Eldoret, Kenya, over a one-year period. Methods: Seventy-nine patients presenting for knee arthroscopic surgeries were evaluated preoperatively using MRI and eight clinical tests. The results from the clinic-radiological tests were compared with arthroscopic findings, which were considered the “gold standard”. Categorical and continuous variables were summarized using frequency tables, and measures of central tendency and dispersion, respectively. The diagnostic tests’ accuracy, sensitivity, specificity, and positive and negative predictive values were also computed for comparison purposes. Results: The patients’ average age was 32.4 years, with a male to female ratio of 1.5:1. Most of the injuries involved the right knee (53.2%). It was also observed that Anterior Cruciate Ligament (ACL) tears (44.3%) were the most prevalent type of knee injuries, followed by medial meniscus (30.4%), lateral meniscus (24.1%), and Posterior Cruciate Ligament (PCL) (12.7%). The study also found that MRI was more accurate than clinical tests in diagnosing medial meniscus (92.41% vs. 50.63%); lateral meniscus (96.2% vs. 72.15%) and PCL (100% vs. 98.73%) injuries. MRI, however, was as accurate (98.7%), sensitive (100%), and specific (97.7%) as clinical examination in diagnosing ACL injuries. Conclusion: Due to its superiority, MRI should be used as a first-line tool in investigating patients with suspected meniscal and PCL injuries. Clinical examination performed by experienced orthopaedic surgeons, however, can be as accurate as MRI in detecting ACL injuries.
Background: Total Hip Arthroplasty (THA) is associated with significant intraoperative and postoperative blood loss. The use of tranexamic acid has been shown to reduce bleeding and the number of blood transfusions. Objective: This study aimed at comparing blood loss and the need for blood transfusion in patients undergoing THA between those who received tranexamic acid and those who did not. Methods: The study design was a hospital-based retrospective comparative study which included 204 patients. The patients were divided into two groups, the first group were those patients who received tranexamic acid preoperatively and the second group were those patients who didn’t receive it. The number of patients who got blood transfusions in both groups was determined. The results were analyzed by Statistical Package for the Social Sciences (SPSS) computer program version 20 for the study variables. Results: The study showed that among the participants who underwent THA, almost three quarter (74.4%) of those who did not receive tranexamic acid needed blood transfusion, whilst 60.3% of patients who received tranexamic acid required blood transfusion. This study also showed that amongst those who received blood transfusion, the number of units were less in the group that received tranexamic acid. Conclusion: Pre-operative tranexamic acid administration to patients who underwent THA showed to be effective in significantly reducing the need and number of units of postoperative blood transfusion.
Background: In 2019, Kenyatta National Hospital (KNH) reorganized its orthopaedic service into seven subspecialty units to align training with global standards. Objective: To evaluate how this reform influenced residents’ perceptions of training quality, mentorship, and educational depth. Methods: A mixed-methods survey was administered to alumni graduating between 2018–2023. Quantitative data were analyzed descriptively and with chi-square tests; qualitative responses were thematically coded. Results: Of the 35 respondents, 71% rated overall training as excellent. Following subspecialization, 71% reported improved mentorship, 89% greater teaching depth, and most valued enhanced focus on areas of interest. All recommended the model for broader adoption. No significant differences emerged between earlier and recent graduates. Qualitative feedback highlighted increased technical confidence and clearer mentorship structures, but also noted challenges such as short rotations and inconsistent supervision. Conclusion: The subspecialty model at KNH was positively received and perceived to improve training quality and readiness. The findings support expanding subspecialty-based education in low- and middle-income countries.
Background: Football poses a significant risk of musculoskeletal injuries. Despite its prominence among the Kenyan youth, there is limited data on the incidence and anatomical patterns of injuries in these young footballers. Objective: This study aimed to determine the incidence and anatomical patterns of musculoskeletal injuries among players in a Kenyan youth football academy during a single football season. Methods: A prospective cohort study was conducted at Express Soccer Academy in Nairobi, Kenya, involving 182 players aged 5–20 years. Participants were systematically recruited and followed for three months during the 2023 season. Data on injuries, including frequency, type, and anatomical site, were collected. Injury incidence rates were calculated per 1000 playing hours. Results: The overall injury incidence was 17.22 per 1000 hours of playing time, with injuries occurring more frequently during matches (62%) compared to training sessions (38%). The ankle (20.21%) and knee (16.50%) were the most affected anatomical sites, with ligament sprains (40.96%) and muscle injuries (36.17%) being the most common types of injuries. Collisions with opponents were the leading mechanism of injury, accounting for 46% of reported cases. Conclusion: This study highlights a high incidence of lower extremity football-related injuries among Kenyan youth players.
Background: The choice of whether to perform Antegrade Intramedullary Nailing (IMN) or Plate Fixation (PF) for midshaft humerus fractures poses a conundrum for the surgeon who must strike the balance between anatomical restoration while reducing elbow and shoulder functional impairment. Objective: This study is concerned with the patient reported outcomes regarding shoulder and elbow function for IMN and PF respectively, as well as an assessment of the radiographic outcomes for either treatment methodology. Methods: A retrospective radiographic review, followed by a prospective cohort study was performed following up all the cases treated surgically for middle third humeral fractures from 2016 to 2022 at a single centre. An analogue pain score, an American Shoulder and Elbow Society (ASES) score for shoulder function and the Oxford Elbow Score (OES) for elbow function were obtained. Retrospectivelyradiographic union was assessed as well as the need for revision or conversion to an alternative treatment strategy. Results: One hundred and three patients met the inclusion criteria. Twenty-four patients participated in the clinical aspect of the study where fifteen had IMN (62.5%) and nine had PF (37.5%.). The shoulder function outcomes showed no statistical difference with an average ASES score of sixty-six for the IMN group and sixty-nine for the PF group. The impairment of abduction score post antegrade nailing was higher in the antegrade nailing group than the plated group. The OES demonstrated greater variance in elbow function in the PF group with the IMN group expressing greater elbow disfunction. Eighty-seven cases were available and eligible for radiographic review where thirteen had delayed unions at 6 months and eight underwent re-operation at the end of the study period. Conclusion: This study demonstrated that treatment of middle third humerus shaft fractures by plate fixation is marginally superior to antegrade intramedullary nailing in preserving elbow function and abduction ability.
