Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach.

Kumar Bs,Satyarup D,Soraganvi P

doi:10.5704/moj.1603.007

Abstract

Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure.Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. Rodriguez- Merchan criteria was used to grade the functional outcome.Results: Of the 54 patients, 28 (58.85%) were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%).The mean (± SD) duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%). Four (7.40%) patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez – Merchan criteria showed that 37(68.51%) of the patients had good and 12 (22.22%) had excellent functional outcome.

Highlights

Fractures of humeral shaft are commonly encountered by orthopaedic surgeons, accounting for approximately 3% of all fractures, which result in significant burden to society from lost productivity and wages 1
In order to seek a better surgical approach with minimal complications this study was undertaken in our hospital with the following additional objectives: 1) the incidence of radial nerve palsy and non-union in anteromedial plate osteosynthesis with anterolateral approach; 2) the mean time required for anteromedial plate osteosynthesis
The most common fracture pattern identified in this study was A3 type 26 which accounted for 48.14% followed by A2 type 13 (24.07%), B2 type 9 (16.66%) and A1 type which was least, 6 (11.11%). (Graph II) The mean (+ SD) duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes

Summary

Introduction

Fractures of humeral shaft are commonly encountered by orthopaedic surgeons, accounting for approximately 3% of all fractures, which result in significant burden to society from lost productivity and wages 1. Even though the majority of humeral shaft fractures can be treated by non-operative methods, the advantages of non-surgical approach are that non-union, wound infection and iatrogenic radial nerve palsy are low 3. Operative treatment are required in a few conditions like open fractures, poly-trauma, ipsilateral humeral shaft and forearm fractures and in cases in which there is failure to tolerate or maintain alignment of functional brace 4. In order to seek a better surgical approach with minimal complications this study was undertaken in our hospital with the following additional objectives: 1) the incidence of radial nerve palsy and non-union in anteromedial plate osteosynthesis with anterolateral approach; 2) the mean time required for anteromedial plate osteosynthesis. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and to measure the functional outcome of this procedure. Rodriguez – Merchan criteria showed that 37(68.51%) of the patients had good and 12 (22.22%) had excellent functional outcome

Methods

Results

Discussion

Conclusion