Humerus Shaft Fractures Research Articles

CLINICAL OUTCOMES OF ANTERIOR BRIDGE PLATING FOR HUMERUS SHAFT FRACTURES BY MINIMAL INVASIVE TECHNIQUE

Near normal acceptable reduction and rigid stable fixation has its biological advantage as compare to absolute anatomical reduction with compromising soft tissue and vascularity. Biological fixation of fractures with soft tissue preservation and near acceptable reduction is becoming a more acceptable entity. However it is to be evaluated. For a satisfactorily outcome only union is not the only requirement but early and acceptable functional usage of the limb is the goal. Therefore concept of biological fixation was developed over a stable mechanical fixation. This has evolved the development and improvement in the techniques of biological fracture fixation and stabilization systems. From conservative cast and braces to internal fixation with intramedullary interlocking nailing, ORIF with plate and screw. Treatment of humeral fracture has evolved a lot with their complications. Studies are still going on to prove superiority of one over another. Minimally invasive technique for humerus shaft fracture has shown promising results recently.
 The present study was planned in Department of Orthopaedic, Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar from jan 2017 to Oct 2017. Total 10 cases with fractures of humerus shaft were treated with Minimum invasive Anterior Bridge plating techniques were evaluated in the present study.
 The data generated from the present study concludes that though the technique is very promising, it has a steep learning curve involved. The greatest advantage is minimally invasive, minimal soft tissue stripping, smaller incisions, minimal blood loss, shorter operative time and early rehabilitation. In conclusion anterior bridge plating (ABP) is very good technique in treating midshaft humeral fractures with minimal soft tissue dissection, smaller scars, and early return to overhead activities.
 Keywords: Anterior bridge plate, humerus fracture, minimal invasive technique, minimal invasive procedure, etc.

Management of paediatric humeral shaft fractures and associated nerve palsy.

PurposeThe aim of this study is to review the management of all paediatric humerus diaphyseal fractures treated at a single institution over a 20-year period.MethodsRetrospective review from between 1996 and 2016 identified 96 humerus shaft fractures in paediatric patients (0 to 17 years). After excluding those deceased from inciting trauma, pathological and perinatal fractures, 80 patients remained for analysis. Data collected included age, fracture type, displacement, nerve palsy, treatment, complications and time to union. Radiographs were reviewed at the time of injury and at latest follow-up.ResultsOf 80 paediatric humeral diaphyseal fractures, 65 (81%) were treated with immobilization. In all, 15 (19%) fractures were treated with surgical stabilization. Most common indications were fracture displacement, open fractures and to improve mobilization in patients with multiple injuries. Fractures were stabilized with a plate (eight), flexible nails (five), external fixation (one) and percutaneous pinning (one). The operative group, compared with the nonoperative group, was older, had more high-energy mechanisms, more open fractures and increased fracture displacement. All patients in the nonoperative and operative groups went on to union with minimal complications. A nerve palsy was present in five patients (6%)with three of the five involving the radial nerve (4%). All nerve palsies were observed and had full neurological recovery.ConclusionOver a 20-year period nonoperative management of paediatric humerus shaft fractures was successful in the majority of patients. Operative stabilization, when rarely indicated, had a low complication rate and improved radiographic alignment. All nerve injuries fully recovered without surgical intervention.Level of evidenceIV

To study the results of humeral Enders nail in diaphysial fracture of humerus

Introduction: It is generally admitted that most humeral shaft fractures can be managed successfully by non-operative methods. Whenever operative treatment is required, a choice has to be made between plate osteosynthesis and intramedullary nailing. Fixation with plates requires extensive dissection and is complicated by the proximity of the radial nerve and the risk of mechanical failure in osteopenia bones. Biomechanically intramedullary nail is a better implant. They are subjected to smaller bending loads and are less likely to fail by fatigue, they act as load sharing devices, stress shielding with resultant cortical osteopenia is minimum, refracture after implant removal is rare and they do not require extensive exposure Methods: We have done a prospective study of 30 patients with Fracture shaft Humerus stabilized with intramedullary nail of Enders type by antegrade approach. These nails were available in 3 & 3.5 mm diameter and in lengths ranging from 18-28 Cms. The nail by design had proximal band of 6 degrees (apex medial band) to accommodate offset of the infusion portal with the medullary canal. Results: Study shows more incidences of Humerus fractures in young patients as it is active age group in the society, more prone to vehicle accidents and falls. Most of the fracture of shaft humerus unites in 10-14 weeks and in minor cases more than 18 weeks were observed for union. Most common complication associated with operative method of fracture shaft humerus is non union. Joint involvement in form of shoulder or elbow stiffness can occur in small number of cases. There are no cases of infection noted in our study Interpretation and Conclusion: Internal fixation by close intramedullary nail for fractures involving middle two third shaft of humerus is a good technique if facilities are provided for image internsifier machine in operation theater. In comparision to other operative techniques close intramedullary nailing is less invasive with minimal blood loss and hardly any chance of infection. This technique gives rotational as well as torsional stability to fractured bone humerus, allowing faster practice of physiotherapy to achieve full range of motion and power.

Surgical management of diaphyseal fractures of the humerus with plate osteosynthesis on anteromedial surface

Background: Humeral shaft fractures represent approximately 1-5 % of all fractures. Non-operative management of humeral shaft fractures is the mainstay of treatment with some drawbacks. The surgical options for a closed humerus diaphyseal fracture are plate osteosynthesis and intramedullary nailing, the previous being gold standard for last four decades. The aim of this study is to evaluate the union rates and functional outcome of anteromedial plate fixation in diaphyseal fractures of the humerus.Materials and Methods: 56 patients treated in a tertiary care medical teaching hospital between June 2015 and May 2019 were enrolled in the study. The humerus was approached by Henry`s approach, fractures were reduced and fixed with 4.5 mm narrow DCP or LCP on the anteromedial surface. All patients were followed up for minimum of 6 months. Modified Stewart and Hundley scoring was used to grade the outcome.Results: Out of 56 patients 41 were males and 15 females, with mean age of 36.5 years. Road traffic accidents were the most common mechanism of injury. The most common fracture pattern was A3 followed by A2. The average time taken for fracture union was 13.8 weeks. 44 patients had excellent to good functional outcome. Three patients had delayed union and one had non-union. None of the patients had iatrogenic radial nerve injury.Conclusion: Plating on anteromedial surface using an anterolateral approach is very good technique for management of humerus shaft fractures with good functional outcome and lesser incidence of radial nerve injury.

Prognostic factors affecting survival of patients with pathologic humerus shaft fractures treated with intramedullary nailing without tumor removal

BackgroundIntramedullary nailing is the procedure of choice for pathologic fractures in humeral shaft because it allows early pain relief and mobilization. The aim of this study was to analyze the prognostic factors affecting survival of patients with pathologic humeral shaft fractures treated with intramedullary nailing without tumor removal. MethodsWe performed a retrospective study by evaluating the records of patients treated in our clinic between 2003 and 2018 for pathologic humerus shaft fractures with a minimum follow-up of one year. Kaplan–Meier methods were applied to estimate overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. Results52 patients (56 humeral fractures) were operated. The average age at the time of surgery was 58.9 years. There were 28 women and 24 men. In our series, multiple myeloma accounted for 52% of the cases. At the time of this study, 34 (65.3%) patients had deceased. Survival rates at first month, 6 months and 1 year after surgery were 96.2%, 67.4% and 59.6%, respectively. The median survival after surgery was 7.5 (6 days-84 months) months for deceased patients and 18 (34.7%) surviving patients with a median survival of 68.6 months. Rapid growth tumor, presence of pathological fracture in other extremities and, Eastern Cooperative Oncology Group performance status (ECOG-PS) were independently associated with a worse overall survival. ConclusionMore than 50% of patients with pathological humerus shaft fractures were diagnosed with multiple myeloma. Rapid growth tumors such as lung cancer and renal cell cancer increased mortality by a factor of 1 while presence of operative metastases in other extremities increased mortality by a factor of 3.1 and ECOG-PS increased mortality by a factor 6.8. Rapid growth tumors, ECOG-PS and presence of pathological fracture in other extremities were important prognostic factors influencing overall survival.

Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures

BackgroundOur hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension.MethodsFrom January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up.ResultsAll patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures.ConclusionsIn spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.

Humerus Nail Retrieval: A Novel New Technique

Antegrade humerus nailing in humerus shaft fracture is one of the treatment options that offer the advantage of maintaining the biophysiology of the fracture but while in case of non union with broken implant insitu its removal comes as an greater challenge. Removal of nail with the help of schanz pin in case of extraction system failure is an novel technique with easy availability of pin in operation theatre and having lesser complication like rotaor cuff injury then other removal technique such as using nibbler or pliar. Cost of this technique is very less compared with arthrocopic removal of humerus nail.

A clinical study of anterior bridge plating for humerus shaft fractures by minimal invasive technique

Introduction: Diaphyseal fractures of humerus treated with bridge plating are showing superior results in view of post-operative pain and union time. In our study we have evaluated the clinical, radiological, and functional outcome of such fractures in 15 patients, all of them were managed with dynamic compression plate over an average follow up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is gold standard, this technique also gives good outcome.Materials and Methods: Fifteen patients with humerus shaft fractures were managed by anterior bridge plating using Minimum invasive osteosynthesis technique between Jan 2017 and Jan 2018 were included in this study. All cases were managed with closed reduction and 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow scores were used for assessing the shoulder and elbow function. Results: Out of the fifteen patients in the study, eleven were males and four were females. The mean age was 40.2 years (range 25 to 60 years). Ten out of fifteen patients (66.67%) had the dominant side fractured. Mean surgical time in minutes was 90min (range: 60–120 minutes). The mean fracture union time was 10.6 weeks (range: 10–18 weeks). However Shoulder function was excellent to good in 13 cases (86.6%), fair in 1 case (6.67%) & poor 1 case (6.67%) on the UCLA score. Conclusion: In our study, small incision percutaneous anterior bridge technique for fracture shaft humerus results in good functional outcomes. It is based on relative stability which provides healing, and subsequent formation of the bone callus, and reduces the possibility of infection and non-union.it requires experience and a good assistance.

A study of functional outcome of humeral diaphyseal fractures treated with dynamic compression plate

Fractures of the humerus comprise approximately 5% to 8% of all extremity fractures, and shaft fractures account for approximately 3% of all long-bone fractures. Majority of humerus shaft fracture can be treated with conservative management but nowadays surgical indications in humerus fracture are increasingly being adopted. In this study 20 patients of humerus shaft fractures has been rated with 4.5 dynamic compression plate with posterior approach in SSG Hospital Baroda. After one year follow up 19 patients out of 20 having good functional result.

EVALUATION OF RESULTS OF INTERNAL FIXATION OF CLOSED, DISPLACED, RECENT FRACTURE SHAFT OF HUMERUS BY MIPPO TECHNIQUE

BACKGROUND: The humerus shaft fracture is the second most common fracture of the upper extremity. The predominant causes of humerus shaft fractures include low energy trauma such as fall from a standing height in older population, while in the younger population it is caused by high energy trauma.&#x0D; Aims and Objectives - To investigate the effectiveness of economical MIPPO technique and to determine the radiological and functional significance of MIPPO technique in the patients undergoing treatment for recent fracture shaft of humerus.&#x0D; MATERIALS AND METHODS: A prospective study had been carried out from December 2012 to August 2014 in the Orthopaedics Department of SSKM Hospital, Kolkata, West Bengal, India. Thirty three patients, who presented with fracture shaft of humerus and underwent fixation of humeral shaft fractures by MIPPO technique were included in this study. Complete history was taken and full clinical examination was carried out.&#x0D; RESULTS: The average age group in our study is 35.3 years. Of them 85% are male and 15% are female. In majority cases, mode of injury was road traffic accident. 85% cases had middle 1/3rd fracture shaft of humerus and the average time interval between the injury and surgery was 8.54 days.&#x0D; CONCLUSION: The results obtained in this study have shown that the MIPPO technique is safe, convenient and effective, since there was minimal soft tissue injury with no major complications.&#x0D; KEYWORDS: Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO); Road Traffic Accident (RTA).

Early Results of Bridge Plating of Humerus Diaphyseal Fractures by MIPO Technique

Anterior bridge plating with minimally invasive technique in humeral shaft fractures is reported as an acceptable, less traumatic and reproducible procedure by several authors. We have evaluated the clini-cal, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plates over an average follow-up period of 22 months. Forty patients with humerus shaft fractures managed by anterior bridge plating using the MIPO technique between 2014 and 2016 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The UCLA shoulder and Mayo elbow performance scores were used for assessing shoulder and elbow function. Of the forty patients followed up for a minimum of 18 months in the study, 26 were males and 14 were females. The mean age was 34.3 years (range 20 to 53 years). 24 out of the forty patients (60%) had the dominant side fractured. The mean surgical time was 72.5 minutes (range: 45-100 minutes) and mean radiation exposure was 160 seconds (range: 100-220 seconds). The mean radiological fracture union time was 13 weeks (range: 8-18 weeks). Shoulder function based on the UCLA score was excellent to good in 33 cases (82.5%), fair in 6 cases (15%) and one patient (2.5%) developed infection for which the plate was removed prematurely at the 4th month and the wound was meticulously debrided and then managed conservatively. Road traffic accident (RTA) was the most common mode of injury, found in 27 cases; 12 patients sustained blunt trauma due to a fall; one patient sustained an injury following a direct blow by stick. 1. The mini-incision anterior bridge technique for humeral shaft fractures gives good functional results and should be considered an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. 2. The mini-incision anterior bridge technique is a safe and less method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

Management of closed shaft of humerus fractures in non admitted adult patients in a tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fracture shaft humerus is among the most common of fractures. Proximal fractures are more common in elderly and are commonly attributed to low-energy falls, they make up to 5% of all fractures and 25% of humerus fractures, middle fractures about 60% and distal fractures contribute to the remaining fractures. Fractures shaft of humerus account for approximately 3% of all fractures encountered by the orthopedic surgeons.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; From November 2017 to October 2018 sixty-two fractures of humeral shaft presented at Emergency Orthopedic Department in Government Medical College Jammu, 30 fractures considered suitable for the study. All these patients were treated conservatively by using the Coaptation ‘U’ shaped slab discharged the next day and evaluation done both clinically and radiologically every two weeks.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; This study showed that the angulation deformities were considerably reduced by the use of U slab and the POP cast. Smoking appeared to have negative effect on the rate of union.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Conservative treatment is one of the most effective methods of treatment. Operative treatment should be limited as much as possible to specific indications given below.&lt;/p&gt;

A study of anterior bridge plating via MIPPO (Minimal invasive percutaneous plate osteosynthesis) for diaphysial fracture of humerus

The internal fixation of shaft humerus fractures has evolved in recent years with a change of emphasis from mechanical to biological priorities. One such biological internal fixation is MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis). Objectives were to document functional and clinical outcomes of anterior bridge plating in diaphyseal humerus fracture, range of motion at elbow and shoulder joint following MIPPO, different complications, and radio-logical parameter like time for fracture union. We have done a obervational study of the 30 patients of fracture humerus treated with minimally invasive percutaneous plate Osteosynthesis from April 2017 to April 2018. More than 50% patients are in the age group of 30 to 50 years.Based on AO classification38% of patients were having simple spiral fracture/A1, 32% of patient was having simple transverse fracture/A3,24% of patients were having simple oblique fracture/A2, 6% of patients were having complex segmental fracture/C2.86% of patient’s post-operative period went event free. 2 patients were having post-operative radial nerve palsy, 2 patients were having superficial infection of stich line. On DASH questionnaire 86% of patients are able to perform activities. The UCLA scoring system rated 21 patients (70%) as a excellent result; 07 patients (26%) as a good result and 2 patients (4%) as a fair result. The MAYO Elbow performance scoring system rated 24 patients (80%) as a excellent result; 05 patients (17%) as a good result and 01 patients (3%) as a fair result. 50% of patients were having union within 12 to 16 weeks, and 43% patient having union within 17-20 weeks and 7% of patient having union at 22 weeks. In comparison with non surgical treatment for humerus fracture and with conventional platting MIPPO technique has very good clinical and functional outcome and also there is less chances of failure of the procedure.

Study of radiological and clinical outcomes by using Anterior Bridge Plating (ABP) for humerus shaft fractures

Study of radiological and clinical outcomes by using Anterior Bridge Plating (ABP) for humerus shaft fractures

Final outcomes of radial nerve palsy associated with humeral shaft fracture and nonunion

BackgroundLittle evidence regarding the extent of recovery of radial nerve lesions with associated humerus trauma exists. The aim of this study is to examine the incidence and resolution of types of radial nerve palsy (RNP) in operative and nonoperative humeral shaft fracture populations.Materials and MethodsRadial nerve lesions were identified as complete (RNPc), which included motor and sensory loss, and incomplete (RNPi), which included sensory-only lesions. Charts were reviewed for treatment type, radial nerve status, RNP resolution time, and follow-up time. Descriptive statistics were used to document incidence of RNP and time to resolution. Independent-samples t-test was used to determine significant differences between RNP resolution time in operative and nonoperative cohorts.ResultsA total of 175 patients (77 operative, 98 nonoperative) with diaphyseal humeral shaft injury between 2007 and 2016 were identified and treated. Seventeen out of 77 (22.1%) patients treated operatively were diagnosed preoperatively with a radial nerve lesion. Two (2.6%) patients developed secondary RNPc postoperatively. Eight out of 98 (8.2%) patients presented with RNP postinjury for nonoperatively treated humeral shaft fracture. All patients who presented with either RNPc, RNPi, or iatrogenic RNP had complete resolution of their RNP. No statistically significant difference was found in recovery time when comparing the operative versus nonoperative RNPc, operative versus nonoperative RNPi, or RNPc versus RNPi patient groups.ConclusionsAll 27 (100%) patients presenting with or developing radial nerve palsy in our study recovered. No patient required further surgery for radial nerve palsy. Radial nerve exploration in conjunction with open reduction and internal fixation (ORIF) appears to facilitate speedier resolution of RNP when directly compared with observation in nonoperative cases, although not statistically significantly so. These findings provide surgeons valuable information they can share with patients who sustain radial nerve injury with associated humerus shaft fracture or nonunion.Level of evidenceLevel III treatment study.

SURGICAL MANAGEMENT OF FRACTURE BOTH BONES FOREARM WITH LOCKING COMPRESSION PLATE IN ADULT PATIENTS

Objective: The objective of this study was to assess the time taken for surgery, tourniquet time, and clinical outcome in diaphyseal fractures of both forearms managed with locking compression plate (LCP).&#x0D; Methods: Patients underwent open reduction and internal fixation with 3.5-mm LCP. Proximal radius was approached by dorsal Thompson incision and middle and distal radius by volar henry approach. A minimum of 6 cortices were engaged with screw fixation in each fragment. Ulna was approached directly over the subcutaneous border.&#x0D; Results: Of 20 patients, 70% were men; fracture was the most common in second and third decades of life. Road traffic accident (50%) and fall (40%) were the main causes. Fractures at mid-diaphysis (70%) and transverse/short oblique (72.5%) were the most common. Closed head injury, unilateral pubic bone fracture, olecranon fracture, fracture of both bones of leg, and ipsilateral fracture shaft humerus were the associated injuries. There was no intraoperative complication. Superficial infection (n=01) and transient posterior interosseous nerve injury, in the immediate postoperative period (n=01), were the reported complications. Average time for surgery was 77 min (60–90 min) and that for tourniquet was 54 min (40–60 min). All had complete union in &lt;6 months; 80% had healing in &lt;4 months. 20% healed in 4–6 months. Excellent and satisfactory results were seen in 85% and 15% patients, respectively.&#x0D; Conclusion: The 3.5-mm LCP, when applied properly, yields excellent outcome in fractures of forearm bones. The use of tourniquet, separate incisions for radius and ulna, and preservation of the natural curves of radius will reduce complications. Clinical outcome in terms of healing and union is excellent.

Humerus Shaft Fractures Occurring in Fly Fishing Boat Riding: Injury Scene Analysis

Humerus Shaft Fractures Occurring in Fly Fishing Boat Riding: Injury Scene Analysis

A study of 40 cases of diaphyseal fracture of shaft of the humerus treated with plate osteosynthesis

Introduction: Different modalities of treatment are available for fracture shaft of humerus. It includes various conservative methods like immobilization in a sling, Thomas arm splint, U slab, hanging cast, shoulder spica cast and surgical treatment such as intramedullary nailing, plate osteosynthesis, and external fixator. These different methods have their own advantages and disadvantages. Method of plate osteosynthesis is sometimes associated with infection and iatrogenic damage to radial nerve. The selection of a method for treating fracture shaft of the humerus depends on various factors which are related to patient and type of fracture. We decided to undertake the study of fracture shaft humerus treated with plate osteosynthesis. Aim: To study patients with diphyseal fracture of shaft of the humerus treated with plate osteosynthesis. Materials and Methods: This was a prospective study of 40 patients with diaphyseal fractures of humerus treated by plate osteosynthesis. All the patients were treated as indoor patients at the Department of Orthopaedics, New Civil Hospital, Surat from January, 2004 to March, 2006. The maximum period of follow-up was 2 years and the minimum period of follow-up was 5 months with average follow-up of 6 months. Patients were operated as soon as they were fit for surgical procedure under anaesthesia. An informed written consent was taken. Most of the patients were operated by posterior approach except two operated through anterolateral approach. AO type narrow 4.5mm dynamic compression plates with 4.5mm cortical screws were used. Patients were called for follow-up regularly at interval of 2-4 weeks as per need. At each visit, patients were examined for pain, tenderness, skin condition, elbow and shoulder movements. All the findings were recorded. Final results were evaluated as per criteria laid down by Hunter. Results and discussion: In the present series, 88% had excellent to good results which were almost consistent with the series reported by Dominik Heim et al. One patient had superficial infection which responded to daily dressing and proper antibiotic use. In Robert and Vander series, postoperative infection rate was 5.6%. In our study, 2 patients had radial nerve palsy at the time of trauma and 1 patient had postoperative radial nerve palsy. Usually, these injuries are neuropraxia. All 3 patients had full recovery within 3-4 months. Conclusion: Though the series is relatively small and the period of follow-up is small, however it appears that: Plate fixation appears to be a good surgical option for treatment of the diaphyseal fractures of humerus. Radial nerve palsy is usually of neuropraxia and it recovers within 4-6 months.

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.

A lifelong story: Case report of a humeral shaft nonunion successfully treated after 30 years

Nonunion of the humeral shaft occurs in 2%–10% of nonsurgically treated fractures and in up to 15% of fractures treated by primary open reduction and internal fixation. Gunshot humerus shaft fractures are a frequent type of injury; the degree of comminution and bone loss, as well as soft tissue disruption may influence the healing process, causing major sequelae with loss of function. Here we describe a 30 years old midshaft nonunion of the humerus, that occurred in a young woman after a gunshot. She was initially treated with hanging cast with definitive nonunion and secondary loss of limb function. After 30 years, careful management of the non union fracture ends, locked intramedullary nailing and bone grafting harvested from the femoral canal using the Reamer Irrigator Aspirator (RIA) system led to union with recovery of limb function.