Humeral Shaft Fractures Research Articles

Proximal humeral fracture-dislocations: which patterns can be reduced in the emergency department?

Shoulder fracture-dislocations can represent a challenging management scenario in the emergency department (ED) because of concern for the presence of occult fractures that may displace during a reduction attempt. The alternative, a closed reduction attempt in the operating room, has the benefit of full paralysis but requires additional resource utilization. There is limited guidance in the literature about the risks of an initial reduction attempt in the ED as a function of fracture pattern to help guide physicians with this decision. This was a retrospective case review of adult patients with shoulder dislocations and fracture-dislocations seen in the ED at a level 1 trauma center over a 10-year period. Imaging and medical records were reviewed to evaluate whether the reduction attempt was successful, unsuccessful without worsening, or unsuccessful with worsening alignment of any fractures, as well as the ultimate clinical outcome. We identified 165 patients with fracture-dislocations and 484 patients with simple dislocations during the same period. Of the patients with fracture-dislocations, 103 had greater tuberosity fractures, 12 had nondisplaced surgical neck fractures, and 50 had displaced surgical neck fractures. None of the patients with simple dislocations had displacement during an ED reduction attempt, including 100 patients aged >65 years. Of the 103 patients with greater tuberosity fracture-dislocations, only 1 had displacement of a humeral shaft fracture during ED reduction. Displacement occurred in 6 of 8 patients with nondisplaced neck fractures who underwent an initial ED reduction attempt vs. 1 of 4 patients who underwent the initial reduction attempt in the operating room. ED reduction was attempted in 25 of the 50 displaced humeral neck fracture-dislocations and was successful in 10 of these (40%). For patients with greater tuberosity fracture-dislocations, there is a low rate of displacement with a reduction attempt in the ED, but an ED reduction attempt in nondisplaced neck fractures is not recommended because of the high rate of displacement. For displaced neck fractures, closed reduction can be successful in select patients. Finally, these data confirm prior reports that closed reduction of simple shoulder dislocations in patients aged >65 years is safe in the ED.

Minimally invasive plate osteosynthesis via posterior approach for type B and C fractures of distal humeral shaft: surgical tactics and a clinical series.

The optimal technique and implant for fixation of multifragmentary fractures of the distal humeral shaft remain inconclusive. We describe the use of minimally invasive plate osteosynthesis (MIPO) via posterior approach and extra-articular distal humerus locking compression plate (LCP-EADH) fixation for 18 such fractures. All fractures were united with a mean union time of 17.6weeks (range 12-20). Transient radial nerve palsy was demonstrated in 2 patients. Six patients had 5° varus angulation and 1 had 5° valgus angulation. Triceps power was Grade 5 in all patients. The mean arc of elbow motion was 127.5 degrees (range 115-140). Six patients had an excellent MEP score and 12 had a good MEP score. As the results, posterior MIPO and LCP-EADH fixation could be an alternative for multifragmentary fractures of the distal humeral shaft, particularly for fractures with a very short distal fragment.

Analysis of feline humeral fracture morphology and a comparison of fracture repair stabilisation methods: 101 cases (2009-2020).

ObjectivesThe aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures.MethodsIn total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate.ResultsThe majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA (P = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA (P = 0.01). Body weight had a positive correlation (r = 0.398) with time to radiographic healing and time to acceptable function (r = 0.315), and was significant (P = 0.014 and P = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate–rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications (P = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups (P = 0.012). There was no significant difference between fixation groups in time to radiographic union (P = 0.145) or time to acceptable function (P = 0.306).Conclusions and relevanceAll three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

Massage Therapy Effectiveness in Rehabilitation on Humeral Shaft Fracture in a Child: A Case Study.

ObjectivesThis case report aimed to explore the process and outcomes of a seven-week massage therapy treatment on post-surgical intervention to reduce humeral shaft fracture.ParticipantAn active 9-year-old girl who recently moved in the region and who underwent two surgeries following a humeral fracture with displacement after a fall at school.InterventionThe treatment used various techniques such as manual lymphatic drainage (MLD), myofascial release (MFR), therapeutic massage, and neuromuscular techniques (NMT) in conjunction with the physiotherapist rehabilitation programme to help the client recover both physically and emotionally from the trauma. Evaluation of the outcome measures (OM) took place throughout the study and after the four-week interim that followed the intervention period.ResultsThe massage therapy intervention indicated improvement regarding range of motion (ROM) and muscular strength. The clients’ progress using the Patient-Specific Functional Scale (PSFS) indicated a gradual evolution to reach almost a 95% gain, and the Upper Extremity Function Index (UEFI) also showed improvement in everyday activities with a 21.5% positive change. The Child Outcome Rating Scale (CORS) and subsequent Child Session Rating Scale (CSRS) monitored therapeutic progress and indicated improvement on biopsychosocial (BPS) aspects throughout the treatment.ConclusionThe client felt strong and more confident after each massage intervention. A combination of techniques and the child’s empowerment positively affected the client’s overall wellness and confidence to return to activities.

Return to work and sport after a humeral shaft fracture.

AimsThe primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS.MethodsFrom 2008 to 2017, all patients with a humeral diaphyseal fracture were retrospectively identified. Patient demographics and injury characteristics were recorded. Details of pre-injury employment, sporting participation, and levels of return post-injury were obtained via postal questionnaire. The University of California, Los Angeles (UCLA) Activity Scale was used to quantify physical activity among active patients. Regression was used to determine factors independently associated with failure to RTW or RTS.ResultsThe Work Group comprised 177 patients in employment prior to injury (mean age 47 years (17 to 78); 51% female (n = 90)). Mean follow-up was 5.8 years (1.3 to 11). Overall, 85% (n = 151) returned to work at a mean of 14 weeks post-injury (0 to 104), but only 60% (n = 106) returned full-time to their previous employment. Proximal-third fractures (adjusted odds ratio (aOR) 4.0 (95% confidence interval (CI) 1.2 to 14.2); p = 0.029) were independently associated with failure to RTW. The Sport Group comprised 182 patients involved in sport prior to injury (mean age 52 years (18 to 85); 57% female (n = 104)). Mean follow-up was 5.4 years (1.3 to 11). The mean UCLA score reduced from 6.9 (95% CI 6.6 to 7.2) before injury to 6.1 (95% CI 5.8 to 6.4) post-injury (p < 0.001). There were 89% (n = 162) who returned to sport: 8% (n = 14) within three months, 34% (n = 62) within six months, and 70% (n = 127) within one year. Age ≥ 60 years was independently associated with failure to RTS (aOR 3.0 (95% CI 1.1 to 8.2); p = 0.036). No other factors were independently associated with failure to RTW or RTS.ConclusionMost patients successfully return to work and sport following a humeral shaft fracture, albeit at a lower level of physical activity. Patients aged ≥ 60 yrs and those with proximal-third diaphyseal fractures are at increased risk of failing to return to activity.Cite this article: Bone Jt Open 2022;3(3):236–244.

Humeral Shaft Fractures: A Literature Review on Current Treatment Methods

In this review, we aim to provide a concise yet comprehensive summation of the assessment and management of humeral shaft fractures. These are uncommon but prevalent enough that they are part of any trauma surgeon's scope of practice. They have historically been treated using non-operative methods, including braces and casts, supported by published excellent results in the rate of the bone union. However, recently published studies challenge these results and suggest the outcomes might be better with surgery, but the complications of an operation such as infection and nerve injury can not be overlooked. In summary, non-surgical treatment is still the gold standard in the treatment of these fractures, but the indications for surgical management are now clearer and include early signs of delayed union and patients who are unable to have a brace fitted or are uncompliant. It is likely that these new developments will start to change practice, and therefore the treatment of humeral shaft fractures should be a topic of interest of any clinician who deals with them.

Surgical correction of a complete diaphyseal humeral fracture of Brahminy kite -a case report

A young Brahminy kite (Haliastur indus) weighing 600g was presented to the Shahedul Alam Quadary Teaching Veterinary Hospital, at Chattogram Veterinary and Animal Sciences University, with a history of trauma due to collision with electric wire, which was unable to fly. Physical examination revealed temperature106ºF, depressed bird with bluish discoloration of subcutaneous tissue from shoulder to elbow joint of right wing and radiographic examination showed complete transverse diaphyseal right humeral fracture. Retrograde intramedullary pinning was done under general anesthesia with diazepam and ketamine combination. Post-operative radiograph confirmed the implant was in position. The total anesthetic period of the surgery was 60 minutes. The present study suggests that, intramedullary pinning can be successfully used for humeral fracture management in kite with proper anesthetic protocol. Postoperative care is very important for a successful outcome in avian orthopedics.

Nonunion of conservatively treated humeral shaft fractures is not associated with anatomic location and fracture pattern.

Humeral shaft fractures make up 1-3% of all fractures and are most often treated nonoperatively; rates of union have been suggested to be greater than 85%. It has been postulated that proximal third fractures are more susceptible to nonunion development; however, current evidence is conflicting and presented in small cohorts. It is our hypothesis that anatomic site of fracture and fracture pattern are not associated with development of nonunion. In a retrospective cohort study, 147 consecutive patients treated nonoperatively for a humeral shaft fracture were assessed for development of nonunion during their treatment course. Their charts were reviewed for demographic and radiographic parameters such as age, sex, current tobacco use, diabetic comorbidity, fracture location, fracture pattern, AO/OTA classification, and need for intervention for nonunion. One hundred and forty-seven patients with 147 nonoperatively treated humeral shaft fractures were eligible for this study and included: 39 distal, 65 middle, and 43 proximal third fractures. One hundred and twenty-six patients healed their fractures by a mean 16 ± 6.4weeks. Of the 21 patients who developed a nonunion, two were of the distal third, 10 of the middle third, and nine were of the proximal third. In a binomial logistic regression analysis, there were no differences in age, sex, tobacco use, diabetic comorbidity, fracture pattern, anatomic location, and OTA fracture classification between patients in the union and nonunion cohorts. Fracture pattern and anatomic location of nonoperatively treated humeral shaft fractures were not related to development of fracture nonunion.

Functional and clinical outcome after operative versus nonoperative treatment of a humeral shaft fracture (HUMMER): results of a multicenter prospective cohort study

PurposeThe best treatment of humeral shaft fractures in adults is still under debate. This study aimed to compare functional and clinical outcome of operative versus nonoperative treatment in adult patients with a humeral shaft fracture. We hypothesized that operative treatment would result in earlier functional recovery.MethodsFrom October 23, 2012 to October 03, 2018, adults with a humeral shaft fracture AO type 12A or 12B were enrolled in a prospective cohort study in 29 hospitals. Patients were treated operatively or nonoperatively. Outcome measures were the Disabilities of the Arm, Shoulder, and Hand score (DASH; primary outcome), Constant–Murley score, pain (Visual Analog Score, VAS), health-related quality of life (Short Form-36 (SF-36) and EuroQoL-5D-3L (EQ-5D)), activity resumption (Numeric Rating Scale, NRS), range of motion (ROM) of the shoulder and elbow joint, radiologic healing, and complications. Patients were followed for one year. Repeated measure analysis was done with correction for age, gender, and fracture type.ResultsOf the 390 included patients, 245 underwent osteosynthesis and 145 were primarily treated nonoperatively. Patients in the operative group were younger (median 53 versus 62 years; p < 0.001) and less frequently female (54.3% versus 64.8%; p = 0.044). Superior results in favor of the operative group were noted until six months follow-up for the DASH, Constant–Murley, abduction, anteflexion, and external rotation of the shoulder, and flexion and extension of the elbow. The EQ-US, and pronation and supination showed superior results for the operative group until six weeks follow-up. Malalignment occurred only in the nonoperative group (N = 14; 9.7%). In 19 patients with implant-related complications (N = 26; 10.6%) the implant was exchanged or removed. Nonunion occurred more often in the nonoperative group (26.3% versus 10.10% in the operative group; p < 0.001).ConclusionPrimary osteosynthesis of a humeral shaft fracture (AO type 12A and 12B) in adults is safe and superior to nonoperative treatment, and should therefore be the treatment of choice. It is associated with a more than twofold reduced risk of nonunion, earlier functional recovery and a better range of motion of the shoulder and elbow joint than nonoperative treatment. Even after including the implant-related complications, the overall rate of complications as well as secondary surgical interventions was highest in the nonoperative group.Trial registrationNTR3617 (registration date 18-SEP-2012).

Similar Complication Rates for Humeral Shaft Fractures Treated With Humeral Nails Versus Open Reduction and Internal Fixation With Plating.

Humeral shaft fractures account for an estimated 3% of all adult fractures. When operative treatment is indicated, intramedullary (IM) nailing and open reduction and internal fixation with plating are the 2 most common techniques. Early IM nails were associated with poor outcomes, but with advancements in nail design, patient outcomes have been improving with this technique. This study used a nationwide database to quantify and compare the rates of postoperative complications between IM nails and plating for humeral shaft fractures in a national population. An administrative database was queried from the beginning of 2010 to the second quarter of 2017 for patients undergoing IM nailing vs open reduction and internal fixation with a plate for humeral shaft fractures. Systemic complications, fracture complications, and mean prescribed morphine milligram equivalents were collected and compared with statistical analysis. The overall rate of complications was high for both IM nailing (30.8%) and plating (34.2%). Patients were at greater risk for radial nerve palsy and infection at 90 days, 6 months, and 1 year if they received plate fixation (P<.05). The plate cohort had a lower risk of rotator cuff repair for all periods (P<.05). Patients in the IM nail cohort had higher rates of hardware removal for all periods (P<.05). Both IM nails and plates have overall similar rates of complications, and either can be used for humeral shaft fractures, based on surgeon preference, skill, and consideration of minor differences in complications between these 2 treatments. [Orthopedics. 2022;45(3):156-162.].

Functional and Radiological Outcome in the Management of Diaphyseal Humeral Shaft Fracture Using the Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) Technique

Introduction: Minimally invasive percutaneous plate osteosynthesis (MIPO) is gaining preference nowadays compared to other treatment modalities for diaphyseal fracture of the humerus. We have evaluated the functional and radiological outcome of diaphyseal humeral shaft fracture with the MIPO technique.&#x0D; Methods: A hospital-based prospective study was conducted on 23 adult patients with diaphyseal fracture of the humerus and treated with the Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) technique. In all cases, 4.5mm locking compression plates were applied. Clinical and radiological evaluation was done at 6 weeks, 3 months, and 6 months.&#x0D; Results: Out of 23 patients, the mean age of patients was 40.3 years. The maximum number of cases were caused due to road traffic accidents 14 (60.9%). The left side was commonly affected with a maximum number of them being Type A fracture 13 (56%) as per AO/OTA classification. The mean operative time was 106 minutes and fracture union was achieved in all patients by the end of 20 weeks (mean 14.83 weeks). In the study group, 1 patient had superficial infection with no evidence of iatrogenic radial nerve injury or implant failure. Shoulder and elbow ROM was restored to normal range.&#x0D; Conclusion: MIPO is a safe and effective technique for the management of diaphyseal humerus fractures, with early fracture healing, less risk of complications such as superficial or deep infection, implant failure, and iatrogenic radial nerve injury, along with a cosmetically acceptable scar.

Epidemiology of proximal and diaphyseal humeral fractures in children: an observational study from the Swedish Fracture Register

BackgroundMost fractures in children are fractures of the upper extremity. Proximal and diaphyseal humeral fractures account for a minority of these fractures. To our knowledge, few previous reports address these fractures. This study aimed to describe the epidemiology and current treatment of proximal and diaphyseal humeral fractures by using the Swedish Fracture Register (SFR).MethodsIn this nationwide observational study from the SFR we analysed data on patient characteristics, injury mechanism, fracture classification and treatment. We included patients aged < 16 years at time of injury with proximal or diaphyseal humeral fracture registered in 2015–2019.Results1996 (1696 proximal and 300 diaphyseal) fractures were registered. Proximal fractures were more frequent in girls whereas diaphyseal fractures were more frequent in boys. The median age at fracture was 10 years in both fracture types but patient’s age was more widespread in diaphyseal fracture (IQR 5–13 compared to IQR 7–12 in proximal). In both sexes, the most registered injury mechanism was fall. Horse-riding was a common mechanism of injury in girls, whereas ice-skating and skiing were common mechanisms in boys. Most proximal fractures were metaphyseal fractures. Most diaphyseal fractures were simple transverse or oblique/spiral fractures. The majority of fractures were treated non-surgically (92% of proximal and 80% of diaphyseal fractures). The treatment method was not associated with the patient’s sex. Surgery was more often performed in adolescents. The most common surgical methods were K-wire and cerclage fixation in proximal fracture and intramedullary nailing in diaphyseal fracture.ConclusionFollowing falls, we found sex-specific sport activities to cause most proximal and diaphyseal paediatric fractures. Further studies on prophylactic efforts in these activities are needed to investigate whether these fractures are preventable. The majority of the fractures were treated non-surgically, although surgical treatment increased with increasing age in both sexes.Trial registrationNot applicable. The present study is a register-based cohort study. No health care intervention had been undertaken.

Elastic Stable Intramedullary Nailing for Pediatric Humeral Shaft Fractures Under Ultrasonographic Guidance: A Retrospective Study.

ObjectiveFixation with an elastic stable intramedullary nail (ESIN) is a widely used technique for the treatment of humeral shaft fractures. Ultrasonography (US) is used as an auxiliary tool and alternative to radiography during surgery to reduce radiation damage, but whether it is effective in pediatric patients is not known. In this study we evaluated the utility of US in the treatment of pediatric humeral shaft fractures by closed reduction and fixation with an ESIN.MethodsChildren who were admitted to our hospital with humeral shaft fractures were retrospectively examined from January 2016 to March 2019. The patients were divided into 2 groups, US (treated by US-guided closed reduction and ESIN fixation) and non-US (treated with the same technique but with intraoperative radiography instead of US). The postoperative functional recovery of the 2 groups was compared.ResultsThe study population comprised 28 boys and 17 girls (age range: 4–16 years) with humeral shaft fractures. US significantly reduced radiation exposure during the operation (P = 0.008), and intraoperative US facilitated the detection of nerve and vascular injury and aided surgical planning. There was no difference between the 2 groups in postoperative recovery based on the Constant–Murley shoulder score (CMS).ConclusionsThese results demonstrate that US-guided closed reduction and ESIN fixation for humeral shaft fractures can limit radiation exposure and help doctors to determine the optimal surgical strategy to avoid radial nerve injury.

Результати лікування переломів плечової кістки при їх різній локалізації (огляд)

Вибір методу лікування при переломі плечової кістки пластиною (відкрита репозиція і внутрішня фіксація) або використовуючи інтрамедулярний остеосинтез є дуже спірним. Ми порівняли результати (зрощення переломів, повторна операція і побічні ефекти) інтрамедулярної фіксації стрижнем та пластиною в пацієнтів із переломами проксимального відділу плечової кістки, а також її діафіза та дистального відділу. Не було виявлено значних відмінностей між інтрамедулярною фіксацією стрижнем і пластиною щодо зрощення перелому, повторної операції або побічних ефектів у пацієнтів із переломами проксимального відділу або діафіза плечової кістки. Доказової бази щодо порівняння інтрамедулярних стрижнів із пластинами при переломах дистального відділу плечової кістки недостатньо. На підставі наявних даних не можна дати жодних рекомендацій. Хірургам, можливо, доведеться продовжувати діяти на власний розсуд, виходячи з особистих переваг, досвіду, а також залежно від характеристик пацієнта та особливостей перелому, перш ніж буде доступна достатня доказова база.

Comparison of Dynamic and Locking Compression Plates in Humeral Shaft Fractures

Objectives: To compare the functional outcome of shoulder in humeral shaft fractures fixed with dynamic compression plate versus locking compression plate. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from March 2018 to February 2019. Study Procedure: This study involved 62 both male and female patients aged between 18-60 years presenting in orthopedic emergency with humeral shaft fracture. These patients were assigned into two treatment groups randomly. Fracture in Group-A was fixed with dynamic compression plate while locking compression plate was used in Group-B. Outcome variable was functional shoulder outcome which was assessed after 12 weeks of treatment using Modified Constant and Murley Score. An informed written consent was gained from every patient. Results: The mean age of the patients was 42.6±12.7 years. There were 45 (72.6%) male and 17 (27.4%) female patients in the study group with a male to female ratio of 2.6:1. The mean BMI of these patients was 27.9±3.4 Kg/m2 and 17 (27.4%) patients were obese. Left side was more frequently involved (53.2%) as compared to the right side (46.8%). Upon follow-up, the Modified Constant and Murley score was significantly higher in patients treated with DCP as compared to LCP (91.3±7.4 vs. 85.8±8.3; p-value=0.008). The frequency of excellent functional shoulder outcome was significantly higher in patients treated with DCP as compared to LCP (87.1% vs. 54.8%; p-value=0.005). When stratified similar difference was observed across various subgroups of patients based on patient’s age, gender, side involved, duration since injury and BMI. Conclusion: Dynamic compression plate was associated with significantly better functional shoulder outcome as compared to locking compression plate in patients with humeral shaft fractures regardless of patient’s age, gender, duration since injury, side involved and BMI which along with cheaper hardware cost advocates its preferred use in future practice. Keywords: Humeral Shaft Fracture, Locking Compression Plate, Dynamic Compression Plate, Functional Shoulder Outcome

Screwed Plate Treatment for Diaphyseal Fractures of Humerus: Case of 15 Patients

Therapeutic arsenal for humeral diaphyseal fractures is huge. It ranges from non-operative treatment to various osteosynthesis techniques by exofixation or endofixation. The goal of our study is to determine the place of screwed plate on diaphyseal fractures of the humerus. We gathered 15 cases of humeral diaphyseal fractures treated by screwed plate out of 106 (14%). The average age of our patients was 37.13 years. The fracture was isolated in six (6) cases and associated with other fractures of 9 patients. The site of the fracture line was at the middle third in 73.3% of cases. The line was transversal in 53.3% of cases, oblique in 20% and comminuted in 6.7% of cases. The average operating time was 13.2 days. All of our patients were treated by dynamic compression plates (DCP). Consolidation was obtained in all of patients over an average time of 74 days. The mean evaluation follow up is 22.2 months. Results, according to the STEWART and HUNDLEY score, were judged excellent in 93.3% of patients. The scar was unaesthetic in 33.3% of cases. Three complications noted were mal union, radial nerve palsy and the infection of the operating site. Osteosynthesis by screwed plate of humeral diaphyseal fractures, though appropriate for specific fractures, gives good clinical results.

Complications in humeral shaft fractures - non-union, iatrogenic radial nerve palsy, and postoperative infection: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft fractures.A PubMed search including original articles comparing different treatments for humeral shaft fractures published since January 2000 was performed. Random effect models with relative risks (RR) and 95% CIs were calculated for treatment groups and outcomes.Of the 841 results, 43 studies were included in the meta-analysis (11 level II, 5 level III, 27 level IV). Twenty-seven compared intramedullary nailing (IM) with ORIF, nine conservative with operative treatment, four ORIF with minimally invasive plate osteosynthesis (MIPO), and three anterior/anterolateral with posterior approach. iRNP risk was higher for ORIF vs IM (18 studies; RR: 1.80; P = 0.047), ORIF vs MIPO (4 studies; RR: 5.60; P = 0.011), and posterior vs anterior/anterolateral approach (3 studies; RR: 2.68; P = 0.005). Non-union risk was lower for operative vs conservative therapy (six studies; RR: 0.37; P < 0.001), but not significantly different between ORIF and IM (21 studies; RR: 1.00; P = 0.997), or approaches (two studies; RR: 0.36; P = 0.369). Post-operative infection risk was higher for ORIF vs IM (14 studies; RR: 1.84; P = 0.004) but not different between approaches (2 studies; RR: 0.95; P = 0.960).Surgery appears to be the method of choice when aiming to secure bony union, albeit risk for iRNP has to be considered, particularly in case of ORIF vs IM or MIPO, and posterior approach. Due to the limited number of randomised studies, evidence on the best treatment option remains moderate, though.

Humeral fractures sustained during arm wrestling.

The aim of this study was to present our experience of treating humerus fracture sustained during arm wrestling. Data of patients treated in our clinic with the diagnosis of humeral shaft fracture due to arm wrestling between 2000 and 2020 was retrospectively reviewed. Data collected included age, sex, dominant arm, history of professional or experienced participation, type and laterality of fracture, presence of radial nerve palsy, other surgical complications, management (surgical or conservative), duration of union defined as the time from injury until callus was evident on the radiograph, and the range of motion of the elbow joint at the last follow-up. Nineteen patients with humeral shaft fracture as a result of the arm wrestling were included. All had right arm fracture and all had right as the dominant side. All of the fractures were spiral at the distal third of the humerus and medial butterfly fragment was present in eleven (57.9%). Seven (36.8%) were treated surgically. Five (26.3%) had radial nerve palsy on admission. At last follow-up, no patient had neural deficit and none had significant loss of range of movement. Arm wrestling is an important cause of humerus shaft fracture. The dominant side is invariably affected. In this series all fractures were spiral type and occurred in the distal third of the humerus. One quarter of patients experienced radial nerve palsy, which can resolve spontaneously. Satisfactory results can be obtained with both conservative and surgical treatment. IV.

Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures

BackgroundThe aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve.MethodsBetween May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS).ResultsA significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups.ConclusionsThe study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.

Factors Affecting Time to Healing in Humeral Shaft Fractures Treated with SIGN Intramedullary Nailing

There is a tendency to treat humeral fractures with the use of splintage in resource poor countries due to a perceived high rate of complications with operative fixation. The Surgical Implant Generation Network (SIGN) intra medullary nail has provided an alternative in the management of humeral shaft fractures. Due to the paucity of research work in this area, our study evaluated factors that influence the time to fracture union in humeral shaft fractures. Fifty-eight humeral Diaphysial fractures were treated over six years. It is a retrospective study. Case notes and the database were analysed. The statistical analysis was done using the SPSS 24 software. The time to fracture healing was the primary outcome variable and how it was influenced by patient and implant variables was studied. The mean time to fracture healing was 17.38 weeks. All 58 fractures united. The mean time to fracture healing in the 20 - 29 years was 16.00 weeks which was lower than in older age groups. Fractures in males healed at 16.33 weeks and in females at 18.76 weeks. Patients with Diabetes Mellitus had a mean healing time of 29.00 weeks, while third proximal fractures healed in a mean time of 15.25 weeks. Age and sex had no significant influence on the time to fracture healing while Diabetes Mellitus, longer duration of antibiotic use, open fractures, and presence of fracture gap post fixation and third middle fractures had increased time to fracture healing.