Fixation Of Humeral Fractures Research Articles

Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies.

Secondary dislocation due to loss of fixation is the most common complication after plate fixation of proximal humeral fractures. A wide range of different techniques for augmentation has been described to improve the primary and secondary stability. Nevertheless, comparative analyses on the specific advantages and limitations are missing. Therefore, the aim of the present article was to systematically review and evaluate the current biomechanical and clinical studies. The databases of PubMed and EMBASE were comprehensively searched for studies on augmentation techniques for proximal humeral fractures using defined search terms. Subsequently, all articles identified were screened for eligibility and subdivided in either clinical or biomechanical studies. Furthermore, the level of evidence and study quality were assessed according the Oxford Centre for Evidence-Based Medicine and the Coleman Methodology Score, respectively. Out of 2788, 15 biomechanical and 30 clinical studies were included. The most common techniques were structural allogenic or autologous bone grafting to enhance the medial support, metaphyseal void filling utilizing synthetic bone substitutes or bone grafts, and screw-tip augmentation with bone cement. Biomechanical data were available for structural bone grafting to enhance the medial support, void filling with synthetic bone substitutes, as well as for screw-tip augmentation. Clinical evidence ranged from level II-IV and study quality was 26-70/100 points. Only one clinical study was found investigating screw-tip augmentation. All studies included revealed that any kind of augmentation positively enhances mechanical stability, reduces the rate of secondary dislocation, and improves patients' clinical outcome. None of the studies showed relevant augmentation-associated complication rates. Augmentation of plate fixation for proximal humeral fractures seems to be a reliable and safe procedure. All common techniques mechanically increase the constructs' stability. Clinically evaluated procedures show reduced complication rates and improved patient outcomes. Augmentation techniques seem to have the highest significance in situations of reduced bone mineral density and in high-risk fractures, such as 4-part fractures. However, more high-quality and comparative clinical trials are needed to give evidence-based treatment recommendations.

Bone healing potential of fascia lata autografts to the humeral head footprint in rotator cuff reconstruction based on magnetic resonance imaging and histologic evaluations

The purpose of the study was to evaluate the bone healing potential of fascia lata autograft (FLA) by magnetic resonance imaging (MRI) and histologicanalysis. The study included 69 patients assessed by MRI after an FLA patch procedure. Three of the 69 patients underwent a revision procedure after the primary FLA procedure; 1 underwent a second-look arthroscopy and 2 underwent reverse shoulder arthroplasties (RSAs). In the 2 RSA patients, we histologically evaluated greater tuberosities with the repaired graft. Moreover, as a control, we harvested the greater tuberosity with the cuff tendon at the time of RSA for failed open reduction-internal fixation of 4-part proximal humeral fracture. Based on MRI, retear cases were divided into type 1 (the graft did not remain on the greater tuberosity) and type 2 (the graft remained on the greater tuberosity). Histologicsections were evaluated to examine fascia-bone or rotator cuff-bone interfaces. There were 35 intact repairs: 7 type 1 and 27 type 2 shoulders (type 1 vs. type 2, P < .001). Second-look arthroscopic findings confirmed that the graft was securely attached to the greater tuberosity. Histologicanalysis of greater tuberosities in RSA patients showed solid continuity of the graft to the bone, with cells with nuclei in the collagen matrix oriented in parallel. The FLA to bone junction consisted of the FLA, fibrocartilage, and bone, which is similar to the normal cuff tendon to bone junction. These results indicate that a fresh cellular FLA has good to excellent bone healing potential.

Screws with larger core diameter and lower thread pitch increase the stability of locked plating in osteoporotic proximal humeral fractures

BackgroundLittle is known about the screw design as a factor for stability of the bone-implant interface in locking plate fixation of proximal humeral fractures. Aim of the present study was to analyze if locking screws with a large core diameter and a low thread pitch provide increased stability when compared to conventional locking screws. Methods3-Part proximal humeral fractures were created in ten pairs of osteoporotic human cadaveric humeri and fixed with a locking plate. Head fixation was performed with screws with a large core diameter (soft bone screws) in one humerus and with conventional cancellous locking screws in the other humerus of each donor. Specimens were loaded in the varus bending position. Stiffness, failure loads, plate bending and motion at the bone-implant interface were evaluated using mechanical sensors and an optical motion capture system. FindingsThe stiffness of the construct for the soft bone screws was 299.8 N/mm (IR, 72.1 N/mm) and 203.9 N/mm (IR, 37.3 N/mm) for the conventional locking screws (p = 0.005). Plate bending did not differ between the two groups. Motion at the bone-implant interface was significantly reduced in the soft bone screw group (p < 0.05). The median load-to-failure was significantly higher in the soft bone screw group (358 N vs. 313 N; p = 0.012). InterpretationThe use of soft bone screws is associated with less motion at the bone-implant interface and therefore greater fixation strength when compared to fixation with conventional locking screws. Clinical studies are needed to prove these biomechanical findings in the in vivo situation.Level of evidence: Controlled laboratory study.

Evaluation of radial nerve continuity early after humeral shaft fracture fixation using high-resolution nerve ultrasonography: a pilot study of feasibility

This study evaluated the feasibility and reliability of high-resolution ultrasonography (HRUS) of the radial nerve in the early, postoperative period after operative stabilization of humeral shaft fractures. This study enrolled patients between September 2015 and April 2018 with a humeral shaft fracture who were assessed with HRUS within 2 weeks after surgery. Based on the ultrasound artifacts, the examiners subjectively defined quality of ultrasound as "bad" or "good." The cross-sectional area of the radial and the posterior interosseous nerve was recorded at predefined locations. The radial nerve was scanned axially in the whole course to identify nerve continuity. Of 44 patients who underwent operations for humeral shaft fracture, HRUS was used to assess 15 patients at an average 4.8 ± 2.6 days (range, 2-11 days) after surgery. The examiners defined ultrasound quality as "good" in 13 of 15 patients (~87%). Primary radial nerve palsy (RNP) was identified in 3 of the 15 patients, and 4 sustained secondary RNP. Nerve continuity was demonstrated by HRUS in every patient. In patients with RNP, nerve continuity was secondarily confirmed by surgical exploration or functional and electrophysiological recovery. Early postoperative HRUS of the radial nerve after osteosynthesis of humeral shaft fractures is a feasible and reliable method to identify radial nerve continuity. In case of pathology, this assessment tool can additionally provide valuable information concerning location and etiology of the RNP.

Locking nail versus locking plate for proximal humeral fracture fixation in an elderly population: a prospective randomised controlled trial

BackgroundProximal humeral fractures (PHFs) are the third most common fracture in older patients. The purpose of the study was to prospectively evaluate the outcomes of PHF fixation with a locking blade nail (LBN) or locking plate (PHILOS) osteosynthesis in a homogeneous elderly patient population.MethodsInclusion criteria were an age > 60 years and the capacity to give informed consent. Patients with isolated tuberosity fractures, previous trauma or surgery, advanced osteoarthritis, fracture dislocation, pathological fractures, open fractures, neurological disorders, full-thickness rotator cuff tears, fracture line at the nail entry point or severely reduced bone quality intra-operatively were excluded.Eighty one patients with PHFs were randomised to treatment using LBN or PHILOS. Outcome measures comprised Constant score, age and gender adjusted Constant score, DASH score, VAS for pain, subjective overall condition of the shoulder (1–6) and active shoulder range-of-motion in flexion and abduction. Plain radiographs were obtained in two planes. All data were collected by an independent observer at 3, 6 and 12 months postoperatively.ResultsThirteen patients were excluded intra-operatively due to rotator cuff tears, fracture morphology or poor bone-quality. Of the remaining 68 patients, 27 in the LBN and 28 in the PHILOS group completed the full follow-up. Mean age at surgery was 75.6 years and the majority of PHFs were three-part fractures (49 patients). Baseline demographics between groups were comparable.All outcome measures improved between assessments (p < 0.001). The LBN group showed improved DASH scores as compared to PHILOS at 12 months (p = 0.042) with fewer incidences of secondary loss of reduction and screw cut-out (p = 0.039). A total of 29 complications (in 23 patients) were recorded, 13 complications (in 12 patients) in the LBN group and 16 complications (in 11 patients) in the PHILOS group (p = 0.941). No significant inter-group difference was observed for any other outcome measures, nor was fracture morphology seen to be associated with clinical outcome or complication rate.ConclusionsAt short-term follow-up, LBN osteosynthesis yielded similar outcomes and complication rates to PHILOS plate fracture fixation in an elderly patient population, though with a significantly lower rate of secondary loss of reduction and screw cut-out.Registration trialNo. DRKS00015245 at Deutsches Register Klinischer Studien, registered: 22.08.2018, retrospectively registered.

Proximal Metaphyseal and Diaphyseal Humerus Fractures

Pediatric humeral proximal metaphyseal and diaphyseal fractures are mostly caused by trauma. Pathological fractures and stress fractures should always be ruled out. Nonoperative treatment is the preferred modality of treatment for most of these fractures. Operative treatment is indicated for open fractures, vascular injuries or if adequate functional reduction cannot be maintained. For pediatric proximal humeral metaphyseal fractures, percutaneous pinning and flexible intramedullary nailing may be necessary, both of which are reported to have good outcomes. For humeral diaphyseal fractures which cannot be managed nonoperatively, elastic intramedullary nailing or plate and screw fixation can be used with good outcomes. These methods of fixation are usually associated with low complication rates. Complications are mainly related to skin and soft tissue irritation by pins or nails or radial nerve injury. External fixation can also used for open fractures with extensive soft tissue injury. While postoperative stiffness is feared complication after surgical fixation of humeral fractures in adults, it is not a common complication after fixation of pediatric fractures. Similarly, nonunions and malunion requiring corrective osteotomy are not common.

Clinical Outcomes and Complications of the Surgical Implant Generation Network (SIGN) Intramedullary Nail: A Systematic Review and Meta-Analysis.

This study is a systematic review and meta-analysis of the clinical outcomes and pooled complication rate of femoral, tibial, and humeral fracture fixation using SIGN nails. We aimed at comparing the pooled rate of adverse events based on the country of study origin, acute versus delayed fracture fixation, and length of follow-up. We searched PubMed/MEDLINE/Cochrane databases from 2000 to 2016 for English language studies. There was substantial heterogeneity among included studies. Therefore, we used subgroup analysis of varying adverse events and removal of potential outlier studies based on the "remove one" sensitivity analysis to address the heterogeneity across studies. A funnel plot was drawn and inspected visually to assess publication bias. We reported pooled complication rates for each adverse event with 95% prediction interval. There were 14 studies with 47,169 cases across 58 different low- and middle-income countries. The average age was 33 ± 14 years, with 83% men and 17% women. Sixty percent of SIGN nails used in these 14 studies were used in femur fracture fixation, 38% in tibial shaft fractures, and the remaining 2% for humeral shaft fractures. Approximately 23% of patients had follow-up data recorded. All studies that measured clinical outcome indicated that >90% achieved full weight-bearing status, favorable range of motion (knee range of motion >90 degrees according to the SIGN database), and radiographic or clinical union depending on the specific variable(s) measured in each study. The overall complication rate was 5.2% (4.4%-6.4%). Malalignment (>5 degrees of angulation in any plane) was the most common complication (7.6%), followed by delayed/nonunion (6.9%), infection (5.9%), and hardware failure, (3.2%). Overall, the use of SIGN nails in fixing femoral, tibial, and humeral shaft fractures demonstrates good results with a high rate of return to full weight-bearing and radiographic/clinical union. The most common complications when using the SIGN nail are malalignment, delayed/nonunion, infection, and hardware failure. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A-prospective study of the outcome of closed intramedullary fixation of humeral shaft fractures treated with multiple K-wires in adults

Objective: To evaluate the feasibility and efficacy of management of fracture of shaft humerus in adults by closed reduction internal fixation with the help of long K-wires followed by immobilization for 3 weeks in splint and then guarded mobilization till fracture united. Methods: This was a prospective longitudinal study. The subjects with fresh diaphyseal humeral shaft fractures without injury to the same limb, transverse/oblique fractures with a large butterfly fragment, comminuted fractures/segmental fragments and long oblique or spiral fracture were included in the study. Patient was taken on the table in lateral position. The general anaesthesia was given. A midline vertical incision of about 3 cms was given on the posterior aspect of distal humerus and the soft tissue dissected. Triceps was split in line with the fibres and the bone was reached. Results: The mean age of the patients was 42.13 (±13.02) years. More than half (69.6%) of the subjects were male. The RTA was among 65.2% of the subjects. The oblique with butterfly type of injury was in 30.4% of the subjects and comminuted was in 21.7%. The middle site of fracture was in 52.2% and left site of fracture was in 52.2%. The antegrade nailing was used among 69.6% of the patients. There was significant increase in the extent of union, constant score and Mayo score from 4 week to 8 and 12 week. The shoulder stiffness was among 65.2% at 4 week which became 13% at 8 and 12 week. The elbow stiffness was in 17.4% of the subjects which decreased to 13% and 8.7% at 8 and 12 week respectively. Conclusion: The present study showed that K-wire fixation for humeral shaft fractures has distinct advantages over other conservative and over operative techniques.

Percutaneous Pinning of Pediatric Proximal Humeral Fractures.

Proximal humeral fractures are relatively common in pediatric patients. These injuries are usually treated nonoperatively in younger children or children with minimally displaced fractures. However, closed reduction or open reduction followed by percutaneous pinning is recommended for older children with displaced fractures. Percutaneous pinning has several advantages, but there are limited reports of a safe and reliable surgical technique in the literature. Patients are positioned in a modified beach-chair position to allow orthogonal imaging. The injured extremity is draped free from the remainder of the body. Closed reduction, which comprises a combination of traction, abduction, and rotation, is attempted. Internal or external rotation may be required, depending on the fracture line and deforming forces. If an anatomic closed reduction cannot be obtained, a block to reduction should be suspected and open reduction should be performed via a deltopectoral approach. Once the fracture is reduced, two 2.5-mm threaded Kirschner wires from the small external fixator set are used to percutaneously fix the fracture. Any small external fixator set can be used, and if not available, individual threaded wires of similar size can be used. Alternatively, Kirschner wires can be advanced to the fracture site prior to reduction and then advanced into the humeral epiphysis once the fracture is reduced. Care is taken to avoid the axillary nerve, which is reliably within 6 cm of the anterolateral aspect of the acromion, and wires are placed distal to this site. Once pin position has been confirmed radiographically, the construct is secured with pin-to-pin clamps to improve rigidity and further decrease the risk of pin migration. A soft dressing and shoulder immobilizer are placed postoperatively. Patients are followed with biweekly radiographs, and pins are removed in the outpatient office or under conscious sedation at 4 weeks. Leaving pins for a longer period may increase the risk of skin irritation and potentially infection. Alternatives to closed reduction or open reduction and percutaneous pinning include nonoperative management and elastic intramedullary nailing. Nonoperative treatment is a reliable option for most patients. However, it is not suitable for older children with severely displaced fractures because of diminished remodeling potential. Elastic intramedullary nailing is a good option for distal fractures. However, it is not suitable for proximal fractures, and it has been associated with longer operative times and more blood loss than percutaneous pinning. It also requires a second procedure. This procedure allows for anatomic fixation of proximal humeral fractures and provides a rigid construct to maintain reduction. It is not technically challenging, requires limited postoperative immobilization, and decreases the risk of a second general anesthetic.

Anteromedial plating for mid-shaft humeral fractures

Background Operative treatment of humeral shaft fractures includes plate osteosynthesis, intramedullary nailing, or external fixation. The present study aimed to evaluate functional and radiological results of fixation of mid-shaft humeral fractures through anteromedial plating.Patients and methods This prospective study was conducted on 21 patients with middle third humeral fractures treated through anteromedial plating. Patients were followed up monthly up to 9 months after surgery. Follow-up included radiograph imaging, pain during rest, the ability to perform ordinary activities, range of movement of elbow joint, and functional assessment using Murphy scoring system.Results The operative functional outcome was excellent in 14 (66.7%) patients, good in four (19.1%) patients, and fair in three (14.2%) patients. All patients returned to preoperative activity levels and achieved full range of movement. Eighteen (85.8%) fractures united 3 months postoperatively, whereas the remainder three patients achieved union within 6 months. Comparison between patients with various clinical outcomes revealed significant association between better outcome and younger age.Conclusion Anteromedial plating is an effective and safe option for humeral shaft fractures. Younger age is associated with better outcome.

The Functional Outcome of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures, case series from a Tertiary Care Hospital

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow fractures were excluded. Oxford Shoulder Score was done at regular intervals for assessment of functional outcome. We did not observe any axillary nerve damage in our case series and the outcomes of 70.5% of our patients were excellent while in 29.5% it was good. We recommend direct lateral approach for specific pattern of proximal humerus fractures.

Comparative study of radiological and clinical outcomes by using single and double interlocking distal screws for humerusshaft fractures

Background: The aim of this study was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on ahumerus intramedullary nail for the internal fixation of humeral shaft fractures. Methods: From April 2010 to April 2015, 30 patients were enrolled with humeral shaft fractures who were operated on using intra medullary humerus nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the humerus nail: in group 1, a single interlocking distal screw was used in 16 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. Shoulder function of patients wereassessed by modified American Shoulder and Elbow Surgeons (ASES) score. Results: We found that 15 (93.7%) fractures achieved union in group 1, and 13 (92.8%) of fractures, in group 2. There was no meaningful difference in the time to bone union and the recovery of displaced fracture fragments between the two groups. At the final follow-up, we found that the scores for shoulder joint modified ASES was 76.2 for group 1 and 79. 1 for group 2. Conclusions: This study shows that if locked appropriately, even a single screw on a humerusnail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.

Cost-effectiveness analysis of total elbow arthroplasty versus open reduction–internal fixation for distal humeral fractures

Total elbow arthroplasty (TEA) and open reduction-internal fixation (ORIF) are 2 viable surgical treatment options for acute, intra-articular distal humeral fractures in elderly patients. Whereas recent systematic reviews and randomized trials have suggested that TEA and ORIF result in similar functional outcome scores, no previous study has assessed the comparative cost-effectiveness between TEA and distal humeral ORIF in this specific demographic. A Markov model was created with the highest-level data available from the literature depicting transitioning health states based on treatment strategies. To populate the quality-of-life data points in the model lacking in the literature, a survey was conducted of patients at 2 referral institutions who underwent TEA or ORIF for acute, intra-articular distal humeral fractures via the European Quality of Life, 5 Domains (EQ-5D) questionnaire at least 2 years postoperatively. Cost data from 2016 for each strategy were used to calculate the comparative cost-effectiveness of TEA versus ORIF. For patients aged 65 years, the total cost of TEA was $19,407 compared with $20,669 for ORIF. The effectiveness of TEA and ORIF was 8.17 and 7.72, respectively. Overall, the incremental cost-effectiveness ratio of TEA ($2375.76/quality-adjusted life-year) was favored more than ORIF ($2677.26/quality-adjusted life-year). These findings suggest TEA is a slightly more cost-effective procedure than ORIF for most elderly patients who sustain acute, intra-articular distal humeral fractures. Still, the unique limitations, complications, and revision rates for each strategy must be carefully weighed for each patient when making a decision.

Outcome of Extra-Articular Distal Humerus Fractures Fixed by Single Column Extra-Articular Distal Humerus Locking Compression Plate Using Triceps Sparing Postero-Lateral Approach

Objective:To determine the time to radiological union and final functional outcome of fixation of extra-articular distal humeral fractures with extra-artricular distal humerus locking plate.Methods:This prospective study was conducted from March 2014 to February 2018 and included extra-articular distal humeral fractures managed by operative fixation using extra-articular distal humerus locking plate. All the fractures were approached using lateral para-tricepetal approach of Gervin, and stabilized with extra-articular distal humerus locking plate with or without lag screws. Time to radiological union was assessed in the follow up and at the final follow up functional outcome was evaluated using Mayo Performance Elbow Score (MEPS). Complications and need for any additional procedures was also recorded.Results:A total of 20 patients with mean age of 36.5 years and an average follow up of 17 months were included. The mean time to radiological union was 17.4 weeks (12 to 36 weeks) which included one delayed union that required bone grafting. The mean flexion at elbow was 127o with only one patient having flexion extension arc movement of less than 100o at the final follow up. The average MEPS at final follow up was 94.7±8 with 19 patients having excellent and good results. Conclusion: Use of extra-articular distal humeral locking plate using lateral para-tricepetal approach in extra-articular distal humeral fractures allows stable fixation of the fracture to allow early return to function with minimal soft tissue dissection and excellent final functional results and minimum complications.

Assessment of functional outcome of surgical management of proximal humerus fracture treated with PHILOS plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal humeral fractures were treated conservatively in the past and often had compromised functional results. With the advancement of surgical techniques, these fractures, especially displaced, are now more often managed operatively; to meet the needs of the patient, provide early rehabilitation and better functional outcome. The aim of this study was to assess the functional outcome of operative management of proximal humeral fractures with Philos plate fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective study, 30 patients aged 19-75 years (mean age 47.1 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients’ functional outcomes were evaluated based on subjective (35 points) and objective (65 points) parameters, as per the constant scoring system.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Functional outcome based on the constant scoring system of the patient at 6 month follow-up were compared. Excellent results were seen in 12 patients (40%), 2 had very good results (6.66%), 9 patients were having good (30%) and 6 had fair (20%) functional outcome. One patient had poor functional results (3.33%). Avascular necrosis (AVN) of the humeral head was observed in one patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and is a feasible option.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Electromagnetic distal targeting system does not reduce the overall operative time of the intramedullary nailing for humeral shaft fractures

IntroductionWe aimed to evaluate the efficacy of the use of the electromagnetic distal targeting system in treating humeral shaft fracture. MethodsPatients were divided in: Group 1) patients that received a distal locking screw placement following the free-hand technique; Group 2) patients in which the distal locking screw was performed using the SURESHOT device. ResultsNo differences were noted comparing Group 1 (freehand) [71,9 range 40–135 min] to Group 2 (SURESHOT)[70, range 25–125 min]. ConclusionThe use of the EM distal targeting system doesn't reduce the overall operative time of the humeral shaft fracture fixation using IMN.

A prospective study of functional, clinical, and radiological outcome of fracture shaft of humerus middle &amp; distal one third treated by mippo technique

The goal of operative treatment of shaft of humerus fractures is to reestablish length, alignment, and rotation with stable fixation that allows early motion and ideally early weight bearing on the fractured extremity. Various methods of treating middle and distal humeral shaft fractures have continued to evolve from closed methods, external fixation, antegrade and retrograde intramedullary nailing, and conventional plating to minimally invasive osteosynthesis. Plate osteosynthesis remains the gold standard of fixation for humeral shaft fractures. biological plate osteosynthesis is important to preserve bone vascularity, also to improve consolidation, to reduce the infection rate, to avoid bone grafting. MIPO techniques avoid direct exposure of the fracture site and transform the implants in an internal extramedullary splint. More flexible fixation should encourage the formation of callus while less precise indirect reduction will reduce operative trauma. This study determines the safety of MIPPO technique and also to evaluate the clinical, radiological, and functional outcomes in the treatment of humeral shaft fractures (middle & distal one third).

Results and analytical outcomes of proximal humerus plating in adults with proximal humerus fracture

Fracture of proximal humerus is the second most common fracture of the upper extremity, following distal forearm fractures. Aim of the present study was to evaluate the efficacy of proximal humerus internal locking system (PHILOS) plate fixation for proximal humerus fractures. Functional outcomes of 12 men and 18 women aged 22 to 78 (mean, 58) years who underwent PHILOS plate fixation for proximal humeral fractures were reviewed. Indications for surgery were 2 part (n=9), 3 part (n=14) or 4-part (n=7) closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system. All patients will be followed up at monthly intervals for 6 months. During this period patient, will be motivated for physiotherapy and gradual normal use of the affected limb. Fracture union will be assessed clinically and radiologically. In our study of fracture proximal humerus union in most of the cases (24) occurring between 10- 14 weeks. Range of union time was 8 to 18 weeks. one case of avascular necrosis of head occur in our case. In out of 30 cases excellent result in 7 cases, Good in16 cases Satisfactory in 5 cases and Poor in 2 cases were obtained. The PHILOS plate fixation is effective treatment for proximal humeral fractures particularly in osteoporotic bones.

Total elbow arthroplasty versus plate fixation for distal humeral fractures in elderly patients: a systematic review and meta-analysis

Background: Distal humeral fractures represent about 1% to 2% of adult fractures. Open reduction and internal fixation (ORIF) has traditionally been the standard treatment; however, fracture comminution and osteoporotic bone may prevent adequate fixation, and total elbow arthroplasty (TEA) is an alternative. The aim of this meta-analysis was to determine which procedure provided superior clinical outcomes for elderly patients with distal humeral fractures. Methods: A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Cases series and comparative studies reporting functional outcomes or complications after TEA and ORIF in patients over 60 yr of age with an acute distal humeral fracture were included. The studies were appraised using validated quality assessment scales. Results were pooled from different studies using meta-analysis techniques, and the functional outcomes, complications, and frequency of revision surgery were compared. Results: The search strategy identified 27 studies: one randomized controlled trial, four comparative studies, 14 ORIF cases series, and eight TEA case series. TEA was associated with statistically significant and clinically superior Mayo Elbow Performance score (MEPS) and Disability of the Arm, Shoulder and Hand (DASH) scores when compared to ORIF in elderly patients while having a statistically significant lower complication rate. Conclusions: Meta-analysis of comparative studies demonstrated that TEA is associated with statistically significant and clinically superior MEPS and DASH scores when compared to ORIF in elderly patients.

A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

BackgroundThe objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different managements for supracondylar humeral fractures in children.MethodsIn January 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for two different managements for supracondylar humeral fractures in children were retrieved. The primary endpoint was the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSix clinical studies with 581 patients were ultimately included in the meta-analysis. There was no significant difference between the closed reduction and percutaneous cross-pinning, and open reduction and internal fixation in terms of the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection (P > 0.05).ConclusionsClosed reduction and percutaneous pinning, and open reduction and internal fixation of supracondylar humeral fractures in children result in similar construct stability and functional outcome. More high quality randomized controlled trials are needed to identify this conclusion.