Humeral Shaft Fractures Research Articles

Radiographic Scoring of Humeral Shaft Fractures Helps Identify Patients at Risk of Surgery for Delayed Union.

Assessing external validity and clinical relevance of modified radiographic union score (mRUS) to predict delayed union in closed humeral shaft fractures initially treated with conservative management. Retrospective cohort. Single urban academic level 1 trauma center. Patients undergoing initial nonoperative treatment of a humeral shaft fracture with a minimum of 3 months follow-up and at least one set of follow-up orthogonal x-rays within 12-weeks of injury. Interobserver and intraobserver reliability of the (mRUS) system for humeral shaft fractures, and establishing an mRUS threshold at 6 and 12 weeks postinjury to predict surgery for delayed union. mRUS demonstrated substantial interobserver agreement on all assessments. Intraobserver agreement was nearly perfect for all reviewers on repeat assessment. mRUS of ≤7 at 6 ± 1 weeks follow-up was associated with surgery for delayed union with an odds ratio of 4.88 (95% CI, 2.52-9.44, P < 0.01), sensitivity of 0.286, and specificity of 0.924. At 12 ± 1 weeks follow-up, the same threshold demonstrated a stronger association with an odds ratio of 14.7 (95% CI, 4.9-44.1, P < 0.01), sensitivity of 0.225, and specificity of 0.981. The mRUS for humeral shaft fractures is reliable and reproducible providing an objective way to track subtle changes in radiographs over time. An mRUS of ≤7 at 6 or 12 weeks postinjury is highly specific for delayed union. This can be helpful when counseling patients about the risk of nonunion and potential early surgical intervention. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Humeral shaft fractures: a cost-effectiveness analysis of operative versus nonoperative management.

Humeral shaft fractures can be managed operatively or nonoperatively with functional bracing in the absence of neurovascular injury, open fracture, or polytrauma. A consensus on optimal management has not been reached, nor has the cost-effectiveness perspective been investigated. A decision tree was constructed describing the management of humeral shaft fractures with open reduction-internal fixation (ORIF), intramedullary nailing (IMN), and functional bracing in a non-elderly population. Probabilities were defined using weighted averages determined from systematic review of the literature. Cost-effectiveness was evaluated with incremental cost-effectiveness ratios, measured in cost per quality-adjusted life-year (QALY). Willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were evaluated. Eighty-six studies were included. Using bracing as the referent in the health care model, we observed that bracing was the preferred strategy at both incremental cost-effectiveness ratio thresholds. ORIF and IMN had higher overall effectiveness (0.917 QALYs and 0.913 QALYs, respectively) compared with bracing (0.877 QALYs). The cost-effectiveness of bracing was driven by a substantially lower overall cost. In the societal model-accounting for both health care and societal costs-the cost difference narrowed between bracing, ORIF, and IMN. Bracing remained the preferred strategy at the $50,000/QALY threshold; ORIF was preferred at the $100,000/QALY threshold. ORIF and IMN were comparable strategies across a range of probability values in sensitivity analyses. Functional bracing, with its low cost and satisfactory clinical outcomes, is often the most cost-effective strategy for humeral shaft fracture management. ORIF becomes preferable at the higher willingness-to-pay threshold when societal burden is considered. QALY values for ORIF and IMN were comparable.

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century.

Background:Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases.Purpose:To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures.Results:Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy.Conclusion:There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.

Humeral Shaft Fractures in Children Incidence, Management and Treatment Effects.

Humeral shaft fractures are relatively rare in children, with incidence between 0.4% and 3% of all fractures in children and between 10% and 20% of all humeral fractures. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at children&apos;s trauma center from january 2012 till december 2021. We retrospectively evaluated the group of 104 skeletally immature patients with humeral shaft fracture treated in our hospital. We have analyzed: age; sex; fracture type, management; time of bone healing; final effect and complications. The non-surgical group consisted of 73 patients (27 girls and 46 boys) with an average age of 8.03 (0.6 - 17.7), while the surgical group consisted of 31 patients (16 girls and 15 boys) with an average age of 12.47 (5,7- 17.8). The mean follow-up was 7.65 months (4-12) in non-surgical group, and 13.38 months (4-24) in surgical group. We have analyzed the results statistically, confirming increase the frequency of the above-mentioned fractures and increase the number of patients treated with surgery. We achieved good effect in all patients. 1. Humeral shaft fractures in children are relatively rare. Although in recent years, we have observed an increase of their frequency; 2. The vast majority of humeral shaft fractures are treated non-surgically with good clinical results; 3. Increase of number of patients treated surgically has been noticeable in the last decade; 4. Surgery is associated with a relatively low risk of complications and allows for cast withdrawal, which significantly improves the patients comfort.

Dynamic Compression Plating Versus Interlocking Nail Procedure for Fracture Shaft of Humerus; A Comparative Study

Objective: To evaluate the efficacy of dynamic compression plating against interlocking nail technique for the treatment of humeral shaft fractures. Study Design: Randomized controlled trial Place &amp; Duration: Department of Orthopedic, Mardan Medical Complex, Mardan for the period of two years from April 2020 to October 2021. Methods: Fifty six patients (18-65 years old) of both sexes were included in the study because they had a humeral shaft fracture. The patients were randomly split into two groups. Both the dynamic compression plating group (n = 28) and the interlocking nail group (n = 28) received treatment. Radiographic examination both before and after surgery were performed. At the 12-day post-operative, complications following the operation were observed. The NEERs criteria were used to analyse the results of the functional assessments. Follow-up was taken at 6 months postoperatively. Results: Mean age of patients was 41.46±10.74 years. 42 (75%) patients were males while 25% were females. Road traffic accident was the most common cause found in 37 (66.07%) patients. Mean union time in DCP and INL group was 11.62±3.05 and 13.54±4.73 weeks. Shoulder stiffness was the commonest complication in both groups. At final follow up, in DCP group 24 (85.71%), 2 (7.14%) and 2 (7.14%) patients had excellent, good and fair outcomes, while in group B (INL) 19 (67.86%), 5 (17.86%) and 4 (14.29%) patients had excellent, good and fair outcomes. No significant difference was found in both groups regarding functional outcomes. Patients satisfaction was high in DCP group as compared to INL. Conclusion: Dynamic compression plating shows better outcomes in term of union time, complications and functional outcomes as compared to interlocking nail Technique. Keywords: Dynamic Compression Plating, Interlocking Nailing, Fracture Shaft of Humerus

Functional outcome of minimal invasive anterior bridge plating for humerus shaft fractures

Objectives: To study clinical &amp; functional outcomes and complications in patients with humeral shaft fractures treated using anterior bridge plating. Materials and Methods: 25 patients with fractures of middle third humerus were treated with Minimum invasive Anterior Bridge plating in a case study at tertiary care hospital Surat. Both male and female patients above 20 years of age with closed and OG type I &amp; II diaphyseal fractures of Humerus were included. Pathologic fracture, OG III fractures, Fractures in skeletally immature patients, Old neglected fractures, Those who Refused to provide informed consent and Fractures with neuromuscular disorders / neurovascular insufficiency were excluded. Functional outcome where analyzed by constant murley shoulder outcome score &amp;Mayo elbow performance index. Results: The totals of twenty-five patients were included in the study. Out of total twenty-five patients 17 were males and 8 were females with the average age of 39 years. Right side fracture was found in 20 patients out of total 25. The average time for the surgery for the entire patient was 68 minutes. The average mean union time was found to be two months (10 weeks) for initial union of surgery.

WHICH SURGICAL TREATMENT IS PREFERABLE IN HUMERAL DIAPHYSEAL FRACTURES? A SYSTEMATIC REVIEW.

Humeral diaphyseal fractures are very common. Many treatments have been proposed but the choice of the best one is often complex. The aim of the proposed study is to analyze the data in the literature in order to define the risks, advantages and disadvantages of the alternative surgical treatments (anterograde/retrograde intramedullary nailing, ORIF, MIPO). PubMed / Medline and Google Scholar were searched for prospective randomized or case-control retrospective studies about surgical treatment of humeral diaphyseal fractures with nailing, ORIF and MIPO, according to PRISMA guidelines. The primary outcome considered was the fracture healing time by comparing nailing-ORIF, nailing-MIPO and ORIF-MIPO. Differences in the rate of post-operative complications, patient satisfaction, intra-operative blood loss and surgical time were considered secondary outcomes. 506 studies were identified, but only 10 studies were valid for the systematic review. No differences between nailing, ORIF and MIPO were recorded in terms of healing and surgical times. Intra-operative blood loss was significantly higher during ORIF (p 0.024). No differences were found in the restoration of function evaluated using clinical scales. The rate of complications was 27.4% for nailing, 21.2% for ORIF and 13.8% for MIPO. The difference was statistically significant only by comparing nailing with MIPO (p 0.012), probably because anterograde nailing is more often correlated to shoulder impairment. ORIF was at higher risk of infection compared to nailing (p 0.007). Humeral diaphyseal fractures require careful pre-operative planning, ensuring reduced healing time, less soft tissue damage and low rate of complications. The lower exposure of the fracture allows for excellent results with reduced bleeding and lower risk of complications.

Anatomical analysis of different helical plate designs for proximal humeral shaft fracture fixation.

Helical plates are preferably used for proximal humeral shaft fracture fixationand potentially avoid radial nerve irritation. Safety of applying fourdifferent long plate designs (straight, 45°-, 90°-helical and ALPS) with MIPO technique as well as assessment and comparison of their distances to adjacent anatomical structures. MIPO was performed in 16 humancadaveric humeri using either a straight (group1), a 45°-helical (group2), a 90°-helical (group3) plate,or an ALPS (group4). Applying CT angiography, distances between brachial arteries and plates were evaluated. All specimens were dissected and distances to the axillary, radial and musculocutaneous nerve were evaluated. No specimens demonstrated injuries of the anatomical structures at risk after MIPO with all investigated plate designs. Closest overall distance (mean(range); mm) between each plate and the radial nerve was 1(1-3) in group1, 7(2-11) in group2, 14(7-25) in group3 and 6(3-8) in group4. It was significantly bigger in group3 and significantly smaller in group1 compared to all other groups, p < 0.001. Closest overall distance between each plate and the musculocutaneous nerve was 16(8-28) in group1, 11(7-18) in group2, 3(2-4) in group3 and 6(3-8) in group4. It was significantly bigger in group1 and significantly smaller in group3 compared to all other groups, p < 0.001. MIPO with 45°- and 90°-helical plates as well as withALPS is safely feasible and demonstrates significantly bigger distances to the radial nerve compared to straight plates. However, thedistances remain small and attention must be paid to the musculocutaneous nerve and the brachial artery when MIPO is applied using ALPS, 45°- and 90°-helical implants.

Is double-crossed retrograde elastic stable intramedullary nailing an alternative method for the treatment of diaphyseal fractures in the adult humerus?

BackgroundThe aim of this study was to compare two techniques for the surgical treatment of diaphyseal fractures in the adult humerus: double-crossed retrograde elastic stable intramedullary nailing (DCR-ESIN) and limited-contact dynamic compression plate (LC-DCP).MethodsThis was a retrospective study conducted at a single hospital. We included 122 patients with diaphyseal fractures of the humerus who had received DCR-ESIN or LC-DCP from January 2011 to January 2017. We compared union rates, union times, disabilities of the arm, shoulder, and hand (DASH) scores at the postoperative 1-year follow-up, and complications between the two groups.ResultsPlating management was performed in 63 patients, while DCR-ESIN was performed in 59 patients. The union rate was higher in the DCR-ESIN group than in the LC-DCP group (100% vs. 90.5%; p = 0.052). The union time was shorter in the DCR-ESIN group than in the LC-DCP group (12.0 weeks vs. 14.8 weeks; p < 0.001). The intraoperative blood loss and operative time were less in the DCR-ESIN group than in the LC-DCP group (76.4 min vs. 129.5 min; p < 0.001; 60.9 ml vs. 244.8 ml; p < 0.001, respectively). The DCR-ESIN had superior results for the rate of overall complications (p = 0.006). At the 1-year follow-up, the DCR-ESIN group had better DASH scores than the LC-DCP group (p = 0.014).ConclusionsThe DCR-ESIN technique, used to treat diaphyseal fractures of the humerus, has shorter operative times, less intra-operative blood loss, shorter union times, and better functional outcomes at 1-year follow-up than the LC-DCP technique. DCR-ESIN may be an alternative method for the surgical treatment of diaphyseal humeral fractures in adults.

Intramedullary Nailing Versus Plate Fixation for Humeral Shaft Fractures: A Systematic Review and Meta-Analysis.

The two techniques most utilized in the surgical treatment of humeral shaft fractures are open reduction internal fixation (ORIF) and intramedullary nailing (IMN). Although there have been multiple comparative clinical studies comparing outcomes for these two treatments, studies have not suggested one approach to be superior to the other. The purpose of this study is to perform a systematic literature review and meta-analysis of studies that evaluated the treatment of humeral shaft fractures with either ORIF or intramedullary nail. We conducted this meta-analysis utilizing stricter inclusion and broader exclusion criteria to examine these two common approaches. We examined those articles which have compared first-time, closed fractures of the humeral diaphysis in adults in fracture patterns that could be treated equivalently by intramedullary nail or plate fixation. The primary outcome of interest was nonunion, and studies that did not report nonunion rates were excluded. There were a total of 1,926 abstracts reviewed and a total of three articles were included in the final analysis after screening. There was no significant difference in the incidence of nonunion between plating (2/111, 1.8%) and nailing (4/104, 3.9%) (P>0.05). The mean difference in average time to union for plated fractures and nailed fractures was 1.11 weeks (95% CI 0.82 to 1.40) which was statistically significant (P<0.05). There was a significant difference in the incidence of radial nerve palsy (12/111, 10.8%) for plating compared to nailing (0/104, 0%) (P=0.0004). There was no difference in incidence of post-operative infection between the two groups intramedullary nailing (P>0.05). The results of this analysis demonstrate an increased risk of iatrogenic radial nerve injury, and a significantly shorter time to union when treating humeral shaft fractures with plating as compared to intramedullary nailing. There was no difference in the rates of nonunion or delayed union. Based on the evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures.

Development of an additively-manufactured functionally-graded expandable implant via the application of the adaptive response surface method: feasibility study on intramedullary humerus nail

The paper introduces the concept of the rational design of a deployable humeral intramedullary nail plug based on a honeycomb structure used for the surgical treatment of humeral shaft fractures. The concept serves for to restore the axial alignment of bone fragments and to maintain stability via bone-nail friction and locking screws. The design nail plug was gained by optimisation process the Latin Hypercube Sampling Design algorithm and Multi-Objective Genetic Algorithm. It was shown that we can use statistical shape function combined by 3 D printing for designing of a new rationally designed implants.

Histological changes and neural elements in the subacromial bursa on patients with rotator cuff tear: Pilot study.

Objective:This study aimed to investigate the neural elements of the subacromial bursa (SAB) in rotator cuff tears.Materials and methods:Twenty patients with rotator cuff tears were recruited, and their visual analog scale (VAS) score, duration of symptoms, and range of motion (ROM), including flexion, external rotation, and internal rotation were evaluated. Tear size was measured using magnetic resonance imaging (MRI). The SAB specimens obtained during arthroscopic rotator cuff repair were studied using routine hematoxylin and eosin staining and immunohistochemistry (S-100 protein and PGP 9.5 protein). The SAB specimen for the control group was obtained from 2 fresh cadavers and 2 patients with acute humeral shaft fracture. The Mann-Whitney U test was applied to assess the difference between histological findings of the rotator cuff tear group and control group. The correlation between the histological findings and clinical features was evaluated using the Spearman correlation coefficient.Results:The mean duration of symptom was 10.2 ± 6.4 months. The preoperative average VAS score was 2.9 ± 1.2. The degrees of preoperative ROM in forward flexion and external and internal rotations were 143.8 ± 19.5, 49.5 ± 23.1, and –4.3 ± 4.2, respectively. The tear was 2.0 ± 0.9 cm. For histological findings, the number of neural elements per low power field in the rotator cuff tear group was significantly less than the control group in both immunohistochemical stainings (S-100: 0.5 ± 0.7 vs 2.8 ± 0.5, p < .01; PGP 9.5: 0.4 ± 0.7 vs 3.5 ± 0.6, p < .01). During the correlation analysis, the number of neural elements in the PGP 9.5 staining was negatively correlated with the ROM in forward flexion and external rotation.Conclusion:This study revealed that chronic rotator cuff tears may induce degeneration of neural elements in SAB.

Functional outcome of operative management of humeral shaft fractures

Fractures of the humeral shaft are common, accounting for approximately 3% of all Orthopaedic injuries according to a study by World Health Organization [1], and result in a significant burden to society from lost productivity and income. These humeral shaft fractures have traditionally been regarded as benign, with high percentage of primary healing with conservative methods. However loss of reduction in the plaster cast invariably leads to malunion. Surgery is however indicated in some of these patients for optimum outcome. With improved implant design and surgical technique, operative management of humeral shaft fractures has increasingly become accepted [2, 3].Study Duration: 1st April 2018 to 1st April 2019Methods and Materials: Purposive sampling method was used to select 45 patients who sustained humeral shaft fractures requiring surgery. A thorough history and clinical examination was done. Age of the patient, etiology/cause of trauma, time and place of injury, occupation of the patient, associated injuries were recorded in a trauma sheet.Patients who presented to hospital immediately after injury and required surgery had careful pre- operative planning done. Blood investigations were taken and pre-operative review done by anaesthetist. Surgery was done under general anesthesia and prophylactic antibiotics were administered in all cases. Treatment consisted of a standard posterior triceps-splitting approach to the humerus. The radial nerve was identified and protected for the duration of the procedure. A dorsal 3.5mm or 4.5mm DCP plate was utilized. A minimum of eight cortices of fixation above and below the fracture site were obtained.Postoperatively, anteroposterior and lateral radiographs were done to assess alignment and reduction of fractures. X-rays were taken immediately post operatively, at 6 weeks and at 6 months. Assessment for pain at the fracture site and evidence of union were checked at 6 weeks, while functional outcome using ASES and Mayo Elbow Performance scores were done at 6 months.Results: 45 patients with humeral shaft fractures were managed operatively by plating. The mean age was 34.6 years. Men accounted for 68.9% (31 out of 45) of the cases. Of these 38 were right hand dominant while the rest were left handed. 26 patients had right humeral shaft fractures while 19 had the left humerus affected. Sixteen patients experienced shoulder pains while 19 were on pain medications. The median shoulder functionality scores in the different age groups ranged from 80 to 85 out of 100. The oldest age group (45 years and above) had lower scores with median score of 80 and range 48.3 to 85.The duration of healing was about 6 months.Conclusion and Recommendations: The results of this study indicate operative management of humeral shaft fractures results in good functional outcomes with little complications. Operative management by plating appears to be method of choice for internal fixation. All patients in this study were fixed by this method.

Exploring patient experiences after treatment of humeral shaft fractures: A qualitative study

IntroductionHumeral shaft fracture treatment can induce serious morbidities, and it is unclear how these morbidities impact patients. To gain in-depth knowledge, we explored how patients experience humeral shaft fractures and the subsequent treatment course. MethodA qualitative study was performed using semi-structured individual interviews. A purposive sampling approach was conducted to recruit patients with traumatic isolated humeral shaft fractures; the patients’ ages, genders, primary treatments, and complications varied. Data saturation was met after the data of 12 patients were analyzed using Malterud Systematic Text Condensation. ResultsEight women and four men with a median age of 48.5 years (range: 22–83 years) were interviewed. The median time from injury to interview was 12.5 months (range: 8–18 months). Ten out of twelve patients were treated non-surgically; of those ten, four patients experienced major complications from the primary treatment. During the analysis, five overarching themes appeared: expectations, physical changes, support and independence, psychological impact, and the specific treatment and recovery. ConclusionFirst, patients with humeral shaft fractures expressed frustration with treatment in the emergency department. Second, gross fracture movement and pain were central symptoms that led to the loss of basic capabilities. Third, patient preferences were included in the treatment decision-making process and could change throughout the treatment course. Fourth, patients required massive support to perform basic activities of daily living.

The Effect of Deformity on Functional Scores in Humeral Shaft Fractures Treated With Functional Bracing

Objectives: The aim of the study is to evaluate the effect of deformity on functional scores of humeral shaft fracture patients who treated conservatively with functional bracing.&#x0D; Materials and Methods: Patients who had humeral shaft fracture and treated with functional bracing between 2014 and 2019, were included in this study. Second or third day, two part functional brace was applied. The deformity angle of the humerus on the anteroposterior radiography was measured and divided into 3 groups. Elbow range of motion (ROM), shoulder abduction and the difference of range of external rotation (ER) compared to contralateral shoulder was evaluated. Moreover, Constant scores of the shoulder and Mayo scores of the elbow were evaluated. &#x0D; Results: Forty-two patients were evaluated. The mean healing time was determined as 12.11 ± 2.31 weeks. Thirty-seven of the patients were successfully treated. Nonunions were detected in only 5 patients during follow-up. The varus deformity was measured between 6°-10° in 18 patients, &gt;11° in 12 patients, and between 0°-5°in 7 patients. In the varus deformity groups, a statistically significant difference was observed for the external rotation measurements (p:0.044) and for elbow ROM measurements (p: 0.048). The reason of the external rotation and elbow ROM measurements difference was &gt;11° varus deformity group. There was no statistically significant difference between the shoulder abduction range, Mayo scores and shoulder constant scores of the varus deformity groups (p&gt;0.05). &#x0D; Conclusion: Our clinical and radiological datas show that satisfactory results are obtained in most of the humeral shaft fractures treated with functional bracing.

Routine fixation of humeral shaft fractures is cost-effective : cost-utility analysis of 215 patients at a mean of five years following nonoperative management.

AimsThe primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate selective fixation for patients at risk of nonunion.MethodsFrom 2008 to 2017, 215 patients (mean age 57 yrs (17 to 18), 61% female (n = 130/215)) with a nonoperatively managed humeral diaphyseal fracture were retrospectively identified. Union was achieved in 77% (n = 165/215) after initial nonoperative management, with 23% (n = 50/215) uniting after surgery for nonunion. The EuroQol five-dimension three-level health index (EQ-5D-3L) was obtained via postal survey. Multiple regression was used to determine the independent influence of patient, injury, and management factors upon the EQ-5D-3L. An incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-year (QALY) gained was considered cost-effective.ResultsAt a mean of 5.4 yrs (1.2 to 11.0), the mean EQ-5D-3L was 0.736 (95% confidence interval (CI) 0.697 to 0.775). Adjusted analysis demonstrated the EQ-5D-3L was inferior among patients who united after nonunion surgery (β = 0.103; p = 0.032). Offering routine fixation to all patients to reduce the rate of nonunion would be associated with increased treatment costs of £1,542/patient, but would confer a potential EQ-5D-3L benefit of 0.120/patient over the study period. The ICER of routine fixation was £12,850/QALY gained. Selective fixation based on a RUSHU < 8 at six weeks post-injury would be associated with reduced treatment costs (£415/patient), and would confer a potential EQ-5D-3L benefit of 0.335 per ‘at-risk patient’.ConclusionRoutine fixation for patients with humeral shaft fractures to reduce the rate of nonunion observed after nonoperative management appears to be a cost-effective intervention at five years post-injury. Selective fixation for patients at risk of nonunion based on their RUSHU may confer even greater cost-effectiveness, given the potential savings and improvement in health-related quality of life.Cite this article: Bone Jt Open 2022;3(7):566–572.

Radial Nerve Paralysis in Diaphyseal Fractures of the Humerus.

One of the most common complications associated with a diaphyseal humeral fracture is the development of a radial nerve injury. We conducted a study to analyze the degree of recovery and prognostic factors associated with radial nerve palsy in patients with diaphyseal humerus fractures. We retrospectively analyzed 28 patients who presented to the Hospital La Fe, Valencia, Spain, with a diaphyseal humerus fracture associated with radial nerve injury between 2010 and 2020. A total of 14.3% (n = 4) of the patients in our cohort had open fractures and 85.7% (n = 24) had closed fractures. There were no statistically significant differences between the type of treatment and the type of fracture (p = .13). There were also no significant differences between the type of treatment and recovery time (p = .42). There was a statistically significant difference (p = .04) in the mean recovery time for patients with preoperative radial nerve injuries (11.9 months) compared with patients who sustained a radial nerve injury secondary to surgical repair of the fracture (8.6 months). The difference in recovery time between patients with open and closed fractures was not statistically significant (p = .3). Results of the study showed that the type of fracture (i.e., open or closed) did not affect radial nerve palsy recovery time. Patients who sustain radial nerve injuries secondary to a surgical repair have a shorter recovery time than patients who sustain primary radial nerve injuries.

Radial Nerve Palsy in Paediatric Humeral Shaft Fractures: Incidence and Management.

Humeral shaft fractures are relatively rare in the paediatric population. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at a children&apos;s trauma centre and assess cases involving radial nerve injury. We retrospectively evaluated a group of 5 skeletally immature patients with radial nerve palsy out of a total of 104 patients with humeral shaft fractures treated in our hospital between January 2011 and December 2021. The study group consisted of four boys and one girl aged 8.6 to 17.2 years (average age 13.6). Mean follow-up duration was 18.4 months. We diagnosed two open and three closed fractures. There were two cases of neurotmesis, two cases of nerve entrapment within the fracture site and one case of neuropraxia. Bone union and functional recovery was achieved in all five patients. 1. Humeral shaft fractures complicated with radial nerve palsy are a challenging medical problem; 2. The incidence of radial nerve injury in the paediatric population is significantly lower than in adults; in our study, it accounted for 4.8% of all humeral shaft fractures; 3. Expectant observation without nerve exploration is reasonable in fractures caused by a low-energy trauma; 4. Early surgical nerve exploration combined with fracture stabilisation is highly recommended in fractures due to a high-energy trauma.

Frequency of Radial Nerve Palsy in Patients with Closed Traumatic Humeral Shaft Fracture in High Energy Trauma Cases

Background: Different pattern of the fractures of the humerus shaft usually result in radial nerve injury. The frequent injury of radial nerve is because of its close proximity to the humeral shaft in the radial groove. Objective: Determining the incidence of Radial Nerve Injuries in Patients with Closed type of Humeral Shaft Fractures in high-energy trauma cases. Material and Methods:Department of Orthopedics conducted this study at Ghurki Trust &amp; Teaching Hospital, Lahore from January 2021 to December 2021, including all patients regardless of gender, aged between 20-60 years with closed fractures at the level of shaft of humerus. All the patients were thoroughly investigated with detailed history, clinical and radiological examination. The patients were originally managed according to standard ward procedures, fracture stabilization with U-slab and analgesic requirements. All of the patients were clinically examined to rule out radial nerve damage. The data accumulated after completion was analyzed using the relative software SPSS version 26.0. Results: This study included 80 patients with radiologically confirmed humeral shaft fractures. There were 55 (68.5%) men and 25 (31.25%) women having this type of fracture pattern. The participants ages were inbetween 20 to 60 years, with men and women having mean ages of 31.62 ±8.35 years and 38.43±5.06 years, respectively, and overall mean age of 38.93± 6.19 years. Spiral fractures accounted for 32 (40%) of the cases, while transverse fractures17 (21.25%), communited fractures16 (20%) and segmental fractures 15(18.75%). In 7 (or 8.75 percent) out of the 80 patients, radial nerve injury was observed. 4 (57.1%) cases of radial nerve damage were found in patients with spiral closed midshaft humerus fractures, 1 (14.3%) reported case in transverse closed humerus shaft fractures, 1 (14.3%) case in comminuted closed midshaft humerus fractures, and 1 (14.3%) case in segmental fractures. Conclusion: This study highlighted the frequency of radial nerve palsy among the patients with humeral shaft fractures at spiral goove . Radial nerve palsy was found in 8.75% of cases presented to our setup.Most of these cases reported in patients with spiral type of fracture of humerus midshaft. These findings are helpful to the surgeons during the pre operative counseling of patients, who suffered radial nerve damage due to a humerus shaft fracture at radial groove. Keywords:Radial Nerve Injury, Closed fracture of the humerus, Radial groove ,Humerus Shaft

Humerus cisim kırıklarında minimal invaziv perkütan plak osteosentezi (MIPPO)

Amaç: Kliniğimizde minimal invaziv perkütan plak osteosentezi (MIPPO) ile tedavi edilen humerus cisim kırıklarının radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.&#x0D; Gereç ve Yöntem: MIPPO ile tedavi edilen 20 hastanın 21 humerus cisim kırığına ait verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, yaralanma şekilleri, AO sınıflaması ve bölgesine göre kırık sınıflaması, sigara kullanımı, radial sinir yaralanması kaydedildi. Radyografik olarak 6. ayda kaynama durumu ve dizilim değerlendirildi. Hastaların son kontrollerinde omuz ve dirsek hareket açıklığı ile objektif, Amerikan Omuz ve Dirsek Derneği (ASES) skoru, California Üniversitesi Los Angeles (UCLA) skoru, Mayo dirsek performans indeksi (MEPI), Kol Omuz El Engellilik (DASH) skoru ve Constant omuz skoru ile subjektif değerlendirme yapıldı.&#x0D; Bulgular: Hastaların ortalama omuz fleksiyonu 169,5°±26,4°, abdüksiyonu 169,5°±26,4° idi. Ortalama dirsek hareket arkı 131,4°±19,8° bulundu. Ortalama ASES ve UCLA skorları sırasıyla 88,5±16,4 ve 32,1±5,2, MEPI ve DASH skoru sırasıyla 93,1±11,3 ve 11,8±20,0, ortalama Constant skoru 9,1±15,3 bulundu. İki hastada 6. ayda kaynamama gözlendi.&#x0D; Sonuç: MIPPO yöntemi humerus cisim kırıklarının tedavisinde; minimal yumuşak doku hasarı, korunmuş omuz ve dirsek fonksiyonları ile başarılı bir tekniktir.