Humeral Shaft Fractures Research Articles

Features of the Rehabilitation of Patients with Fractures of the Humeral Diaphysis after Osteosynthesis

Aim: Determination of the target criteria of physical rehabilitation and the optimal time of their implementation depending on the methods of fixation of fractures of the humeral diaphysis. Materials and methods: The results of treatment of 59 patients with diaphyseal humeral fractures have been studied. All patients underwent extra- or intramedullary osteosynthesis. Results: In the absence of satisfactory stability of fracture fixation (Group A), passive movements and no active movements are recommended, especially in the presence of free bone fragments that serve as a site for muscle insertion (Group A1). The presence of free fragments with stable fixation (Groups B1 and B2) determined the possibility of active adduction and abduction movements of the shoulder. Complexes of physical rehabilitation exercises with the exclusion or prohibition of active rotational movements have been chosen for patients of Groups C1 and C2. Conclusions: The proposed system of distribution of physical load during the rehabilitation period according to the “ABC” type provides a biomechanically based approach to the rehabilitation process.

Hybrid Ilizarov’s Method and Fibular Strut for Humeral Diaphyseal Nonunion: A Case Report after Multiple Failed Plating

Humeral diaphyseal fracture with non-union and failed implant in situ is a complex case. It is more challenging when the case is accompanied by infection, multiple ORIF, and osteopenic bone. Smoking and alcohol consumption synergically enhances delay in fracture healing and nonunion. The various surgical procedures are prevalent and conducted by orthopedic surgeons for its management. We hereby present a complex case of non-union humeral shaft fracture with an implant in situ by the use of autologous fibula strut as a biological nail to fit the non-union gap stabilized by K-wire and hybrid Ilizarov’s external fixator for mechanical support in a single setting. During this process, radical bone debridement was done. At 9 months of follow-up, bone union was achieved and the implants were removed. The final functional outcome was graded as good according to QuickDASH shoulder score with improved shoulder and absence of pain at the non-union site.

Atrophic pseudarthrosis of humeral diaphyseal fractures: medico-legal implications and methodological analysis of the evaluation.

Humeral shaft fractures account for 1- 3% of all fractures and about 20-27% of those involving the humerus. In the past they were often conservatively treated, with an acceptable consolidation rate. Open reduction and internal fixation (ORIF) is the best choice in polytrauma patients, in complex or pathological fractures and in those associated with vascular injuries. Regardless the type of fixation used, these fractures can evolve into delayed union or pseudarthrosis (PSA). It should be noted that the humeral shaft itself has a high intrinsic healing potential, due to the blood supply provided by the surrounding muscles. The aim of this work is to evaluate whether the causes that led to the development of atrophic pseudarthrosis in a humeral diaphyseal fracture are attributable to inadequate management of this fearful complication and to highlight the possible medico-legal repercussions. We will try to verify whether the currently used forensic evaluation parameters of permanent disability are appropriate and adequate in relation to the complexity of such injuries. This complexity also includes the repercussions on the ergonomic efficiency of the entire limb, the relative possible postural alterations, the inevitable extension of the period of traumatic illness and the relative repercussions on the overall compromised structure of the subject. (www.actabiomedica.it)

Evaluation of the treatment efficacy of titanium elastic nail in addition to external fixator in humeral diaphyseal fractures: Comparison of three treatment methods

Objectives: This study aimed to compare the clinical and radiological outcomes of combined titanium elastic nailing and external fixator application (TEN+EFA) with EFA and plate osteosynthesis in patients with humerus diaphysis fractures. Material and Methods: Data of the patients who underwent surgical treatment for a humerus diaphysis fracture were retrospectively reviewed. The patients were divided into three groups based on the surgical technique. Group 1 consisted of the patients who underwent plate osteosynthesis, Group 2 included those who underwent EFA, and Group 3 included those who went through TEN+EFA. Results: Eighty patients were included. The number of patients in the study groups was 32, 25, and 23 in Group 1, 2, 3, respectively. The duration of surgery was statistically significantly shorter in Groups 2 and 3 than in Group 1 (p=0.02). Nonunion was diagnosed in 3 patients (9.3%) and in 1 patient (4%) in Groups 1 and 2, respectively. The presence of nonunion was not statistically significant. (p=0.28) Malunion was encountered in 2 patients (4%) in Group 2, while no patients experienced malunion in Groups 1 and 3. The presence of malunion was not statistically significant. (p=0.10) Conclusions: The EFA+TEN is a practical, safe and fast procedure providing a minimally invasive surgical treatment option for patients with humerus diaphysis fractures.

Dynamic compression plating with interlocking nailing for fracture shaft of humerus in adult: A prospective study

Background: In orthopaedics, a humerus fracture is a frequent yet difficult to treat problem. Unless complicated, these are normally treated non-operatively (with a hanging arm cast, U cast, or U slab). Complete union is not always required since the bone has a dense covering of muscles and blood vessels. The goal of this study was to see if there was a difference between dynamic compression plating (DCP) and intramedullary interlocking nailing in diaphyseal humeral fractures in adults. Methods: It was a prospective study undertaken at MGM Medical College and L.S.K. Hospital in Kishanganj, Bihar, in the department of orthopaedics. During the study period of November 2020 to September 2021, a total of 40 cases were enrolled. The participants in the study were randomly assigned to one of two groups. One closed reduction and internal fixation with antegrade intramedullary interlocking nail-group, and one open reduction and internal fixation with dynamic compression plating-group. Results: We found that the final outcome in between the groups, comparison of DASH score, maximum number of excellent cases were Dynamic compression plating group. i.e. 80.0%, good-13.3%, Fair was 6.7% respectively. In another Interlocking nailing group excellent cases were found 26.7%, good-33.3%, fair- 26.7% and poor was 13.3% respectively. We have found statistically significant p value -0.028. Conclusion: There appears to be a substantial difference in radiological union or rate of union between the two groups; nonetheless, based on complications and functional results, Dynamic compression plating is a good fixation method

Open reduction and internal fixation (ORIF) of right humeral diaphyseal fracture in a rusty spotted cat (Prionailurus rubiginosus)

Open reduction and internal fixation (ORIF) of right humeral diaphyseal fracture in a rusty spotted cat (Prionailurus rubiginosus)

Functional outcome of midshaft humerus fracture treated with minimally invasive anterior plate osteosynthesis

Introduction: Humeral shaft fractures make up approximately 1% of all fractures. Typically, they are the result of direct trauma. Though open reduction and plating technique of humerus shaft fracture is prevailing, Minimally invasive plate osteosynthesis technique also gives favorable outcome. This techniques are challenging and have the benefitof reducing soft- tissue damage.Materials and Methods: Twenty two patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with locking compression plate fixation in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time were noted. The constant Murley score for shoulder and Mayo elbow performance score for elbow were used for assessing the shoulder and elbow function.Results: Of the twenty two patients in the study, 54.4% were males and 45.5% were females. The mean age was 45.8 years (range 21 to 85 years). 59.1% patients had the left side fractured. RTA was most common mode of injury. Mean surgical time in minutes was 71.36 mins. The mean fracture union time was 12.82 weeks. At the end of 1-year follow-up, mean constant score was 87.9 and mean Mayo score was 97. 20 patients had no post-op complications and 2 had delayed union.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique should be considered as an effective, cosmetically advanced surgical option. It is a safe and less time consuming method for simple types of humeral shaft fracture.

EPIDEMIOLOGICAL STUDY OF SURGICALLY TREATED HUMERAL SHAFT FRACTURES - A 10-YEAR REVIEW.

To assess the prevalence, demographics, and associated injuries of surgically treated humeral shaft fractures. A retrospective study between 2009 and 2019 with patients undergoing osteosynthesis of humeral shaft fracture. Categorical variables were assessed using Fisher's chi-square or exact test, and non-categorical variables were assessed using the unpaired t-test. A significance level of 5% was adopted. A total of 115 patients were evaluated. Mean age was 37.9 ± 15.6 years, with a male predominance (66.9%) due to car accidents. The most prevalent fracture type was 12 A3. Open fracture prevalence was 11.3%. Radial nerve damage prevalence was 33% and low-energy trauma was twice as likely. Surgically treated humeral shaft fractures were more prevalent in men, young, and related to high-energy trauma, with a transverse line pattern. Fractures secondary to low-energy trauma had a greater association with radial nerve injury. Level of Evidence III, Epidemiological, Retrospective Study.

Systematic Review and Meta-Analysis of Patient Reported Outcome and Return to Work after Surgical vs Non-Surgical Mid Shaft Humerus Fracture

Background: Several recent reviews demonstrate that in patients with humeral shaft fractures, surgical therapy has lesser risks of non-union, mal-union, and re-intervention than non-surgical therapy. These positive clinical outcomes of the surgical approach make it a preferable treatment option despite the risks of radial nerve palsy and additional surgery-related risk. We aimed to evaluate patients' outcomes and return to work after surgical vs. non-surgical management of shaft humeral fracture. Methods: We used databases, including PubMed, Medline, and Cochrane Register of Controlled Trials from 2010 to January 2022 to search potential randomised controlled trials (RCTs) and cohort studies comparing the patients' related outcome measures and return to work between surgical and non-surgical management of humerus fracture. Results: After carefully evaluating 1352 articles, we included three RCTs (232 patients) and one cohort study (39 patients). The surgical intervention used plate/ nail fixation, while the non-surgical intervention used splint or brace procedure to manage shaft humeral fracture. The pooled DASH effects of all three RCTs at six (M.D: -7.5 [-13.20, -1.89], P: 0.009) I2:44%) and 12 months (M.D: -1.32 [-3.82, 1.17], p:0.29, I2: 0%) were higher in patients treated surgically than in non-surgical procedures. The pooled constant Murley score at six (M.D: 7.945[2.77,13.10], P: 0.003) I2: 0%) and 12 months (M.D: 1.78 [-1.52, 5.09], P: 0.29, I2: 0%) were higher in patients who received non-surgical than surgical therapy. However, pooled analysis for patients returning to work for both groups remained inconclusive. Conclusion: Altogether, we found no significant evidence supporting the clinical benefits of surgical over non-surgical therapy. Thus, the non-surgical approach remains the preferred therapeutic choice for managing shaft humeral fractures due to its lesser side effects

Humeral shaft fractures in overhead throwing athletes: A case series

Humeral shaft fractures in overhead throwing athletes: A case series

Ultrasound Evaluation of the Rotator Cuff after Osteosynthesis of Humeral Shaft Fractures with Interlocking Intramedullary NailA Prospective Interventional Study

Introduction: Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. However, shoulder impairment remains an important complication of intramedullary nailing. The procedure involving the splitting of supraspinatus tendon to expose humeral head for nail insertion has been attributed for it, even though it is followed by the repair of the tendon. Aim: To evaluate rotator cuff integrity with Ultrasound (USG) in patients who underwent humeral fracture fixation with an intramedullary interlocking nail and to evaluate the clinical outcome of the shoulder joint in patients with and without rupture of the rotator cuff using constant murley and QuickDASH scores. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics of AJ Institute of Medical Sciences, Mangaluru, India, from August 2018 to September 2020 in which 20 adult patients with acute humeral shaft fractures were treated with closed intramedullary nailing in antegrade manner. Patients were followed-up for six months clinically and radiologically. The USG evaluation of rotator cuff was done at six months follow-up, along with clinical evaluation using constant Murley and QuickDASH scores. Association between variables was analysed by using Chi-square test for categorical variables. Unpaired t-test was used to compare the mean of quantitative variables. The level of significance was set at 0.05. Data were entered into Microsoft excel (Windows 7; Version 2007) and analyses were done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 22.0; SPSS Inc, Chicago). Results: At six months follow-up, patients were evaluated by USG showing ruptured supraspinatus tendon in 3 (15%) of the study patients. The results by constant murley score were 76.50±12.61 for the entire series, 77.82±12.75 for patients without rotator cuff rupture, and 69±10.53 for patients with partial rupture of the rotator cuff, with no statistical difference (p=0.275). QuickDASH scores were 9.90±7.69 for the entire series, better in the group without rupture of the rotator cuff (9.41±7.92 versus 12.70±6.84) but without statistically significant difference (p=0.510). Conclusion: The functional outcome of the shoulder joint is satisfactory and is not influenced by the presence or absence of a rotator cuff tear following the procedure.

Evaluation of the results of anterior minimally invasive plate osteosynthesis in treating humeral shaft fractures

Background The advantages of minimally invasive plate osteosynthesis (MIPO) are less soft tissue dissection and less blood loss with excellent results. This study aims to assess the outcomes of MIPO in treating humeral shaft fractures. Patients and methods Anterior MIPO was performed on 30 patients from March 2017 to January 2019. The inclusion criteria for this prospective study included a fracture located at the middle third of the humeral shaft, a fracture with polytrauma, and fractures with early conservative treatment failure. Type A fracture was the most common according to the AO-OTA classification (13 cases), followed by type B (11 cases) and type C (six cases). The space between biceps and brachialis was identified, and a locking compression plate or limited contact dynamic compression plate was used. The minimum follow-up period was 1 year. The outcome measurements included fracture union, alignment, infection, range of motion, functional assessment as per the University of California at Los Angeles shoulder score, and elbow function as evaluated using the Mayo elbow performance index. Results The mean operation time was 90.30 min (range, 80–180 min), and mean radiation exposure was 204 s (range, 110—420 s). All fractures united. The mean fracture union time was 15.3 weeks (range, 10–18 weeks). There was no incidence of implant failures. The mean University of California at Los Angeles end-result score was 34 points (range, 32–35). The mean Mayo elbow performance index was 98 points (range, 90–100). The mean range of motion was 135° (range, 100–140°). The functional outcome was satisfactory. Conclusion MIPO is an excellent method for treating humeral shaft fractures. It might decrease the perioperative complications with a reduced operation time.

A case of pseudoaneurysm associated with pseudoarthrosis of humeral shaft fracture

A case of pseudoaneurysm associated with pseudoarthrosis of humeral shaft fracture

Distal Humeral Diaphyseal Open Fracture in a Child with Bone Loss

Distal diaphyseal humerus fracture is less common than supracondylar humeral fracture and its open fracture is even less. This is a case report of open distal humeral diaphyseal fracture on the left arm with bone loss in 10 years old male who sustained the injury from fall, diagnosed as Grade III open unstable distal diaphyseal shaft fracture of left humerus with bone loss without neurovascular deficit. We performed Open Reduction /Internal Fixation (OR/IF) and free bone fragment was flipped and fixed to the bone fragments and maximum possible contact was made and fixed with an external fixator. Range of motion was advised as early as possible. At final follow up the result was excellent as per Flynn's criteria. OR/IF (Open Reduction /Internal Fixation) of this fracture with posterior approach and flipping the bone to get more contact seems good and safe procedure. Further, external fixation provides reasonable fixation in these cases.

New ways of treatment of fractures of the humeral shaft: does the combination of intramedullary nail osteosynthesis and cerclage improve the healing process?

IntroductionThe humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage.MethodsIn this retrospective study, 109 patients were evaluated, who, during a period of 6 years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS.Results and conclusionThe healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.

Outcome of Pediatric Humerus Fracture Treated With Close Reduction and Elastic Intramedullary Nailing

Introduction: Pediatric humeral shaft fractures are infrequent fractures only secondary to trauma or any of the pathological changes in the bone; representing two to 5.5% of all pediatric fractures and occurring predominantly in children younger than three years or older than 12 years of age. These fractures can usually be treated conservatively with functional bracing and splints however conditions like inability to maintain an acceptable reduction, open fractures, floating elbow, closed head injury, and polytrauma patient requiring early weight bearing warrant the surgical intervention. The intramedullary elastic nails have been found to be more effective in treating fracture shaft of humerus of pediatric age group in comparison over other implants used. Aims:The aim of this cross-sectional observational study was to evaluate the outcome of shaft of humerus fracture in children treated with retrograde intramedullary kirschner’s wire. Methods: This prospective study was conducted in the department of Orthopedics in Nepalgunj Medical College Teaching, Kohalpur from January 2020 to March 2021 in 26 children. Children were evaluated for age, sex, side of injury, mechanism of injury, time period for union, implant removal time, outcome and accompanying complications. Patients were evaluated using Broberg and Morrey scoring system for elbow functions and modified Dash criteria for shoulder function. Results: In this study of 26 children, 65.4% were boys and 34.6% were girls with average age of 9.58 ± 2.1 years. Left side was prominent side for injury with 69.2%. The average duration for union was found to be 10.04 ± 1.42 weeks. The implant was removed at 24.19 ±1.57 weeks. Based on Broberg and Morrey score system for elbow, 23 (88.46%) children had excellent result and three (11.54%) had good result. While evaluating for Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder joint evaluation; all children had excellent result. Conclusion: The treatment of pediatric humeral shaft fracture by close reduction and intramedullary kirschner’s wire is safe, easy and cost effective operative procedure with good results.

Anatomical variations in the sensory innervation of the dorsal surface of the first digit space, a cadaveric study with clinical consequences

IntroductionRadial nerve palsy is a classical complication of a humeral shaft fracture. In clinical practice, motor palsy of the radial nerve is sometimes observed without an abnormality felt in the sensory territory. HypothesisWe hypothesised that this dissociation between sensory and motor involvement is related to anatomical variations of the sensory innervation of the dorsal surface of the first digit space, thus, we decided to study the nature and frequency of these variations. Material and methodA cadaveric study was conducted on 24 upper limbs to analyse the truncal origin of the sensory branches innervating the dorsal surface of the first digit space. ResultsThe sensory branch of the radial nerve (SBRN) participated in the innervation of the dorsal surface of the first digit space in 22 limbs, an anatomical variation was present in 2 cases with a mixed innervation by the SBRN and the lateral cutaneous nerve of forearm (LCNF) in 1 case and singular innervation by LCNF, with no SBRN involvement, in 1 case. Communications between SBRN and LCNF were found in 7 cases. DiscussionPure motor radial damage, without a sensory deficit of the dorsal surface of the first digit space, does not preclude a complete traumatic injury of the radial nerve. The sensory innervation of this region can be relayed by a branch of the LCNF. Level of evidenceIV; cadaveric study.

Distal 3rd Diaphysial Fracture of Humerus Fixed with Dynamic Compression Plate Using Posterior Approach- The Assessment of the Outcome

Objectives: The effectiveness of open reduction and Dynamic Compression Plate (DCP) fixation with or without autogenous bone grafting using the posterior midline approach in the treatment of distal third diaphyseal humeral fractures was assessed.
 Methods: For humeral nonunion, comminuted fractures, or early failure of conservative therapies, 33 patients (24 men, 9 women; mean age 37 years; range 20 to 60 years) were operated on. The study was carried out at Dhaka Medical College Hospital (DMCH), Dhaka from July 2005 to December 2006.
 Results: After an average of 17 weeks, all of the patients had union (range 14 to 26 weeks).There was no deep infection, nonunion, malunion, implant failure, or nerve injury in any of the patients. In two cases, transient radial nerve palsy occurred. Minor infections were seen in four of the individuals. All of the patients were pain-free after surgery.The functional outcome was outstanding in all instances and good in 16 patients, yielding 87 % satisfying results. Functional outcomes increased considerably postoperatively compared to preoperatively (p<0.001). In 20 individuals, the range of motion of the shoulders was great. The range of motion at the elbow was considerable in 21 patients and moderate in seven others. More than three-quarters of the patients (75.8%) experienced no problems. Four patients (12.1%) were infected, and two patients (6.1%) developed iatrogenic radial nerve palsy as a result of the surgery. One patient (3%) had a loose screw, while another (3%) needed blood transfusions owing to extensive bleeding at the donor graft site.
 Conclusion: In distal third humeral fractures, open reduction and posterior DCP fixing, with or without autogenous bone grafting, is a safe and effective treatment option, especially when there is no infection or bony or neurovascular damage. Very few study conducted on distal 3rd diaphysial fracture of humerus fixed with DCP using posterior approach, therefore this study conducted to know the assessment of the outcome.

Surgical Treatment of Radial Nerve Injuries Associated With Humeral Shaft Fracture-A Single Center Experience.

Radial nerve injuries are often associated with humeral shaft fractures. The results of treatment of these injuries, by contemporary surgical approaches, remain diverse. In this paper we presented the outcomes and analyzed the patient, clinical, and surgical procedure related characteristics and factors that may influence the outcome overall, in 77 patients treated at Clinic for Neurosurgery, Clinical Center of Serbia during a 20 years period. The nerve injuries were verified by US and EMNG. The majority of patients were treated by neurolysis or sural nerve grafting, while only few were treated by direct suture. The final recovery was evaluated by muscle strength assessment and classified using MRC. We analyzed extension of the wrist, extension of the fingers including the thumb, and abduction of the thumb. There was a significant statistical difference in MRC grade following the treatment. The total rate of useful functional recovery was achieved in 69 (89.61%) out of all studied patients, out of whom 20 (28.99%) achieved excellent recovery, 26 (37.68%) achieved good recovery and 23 (33.33%) achieved fair recovery. Only 8 (10.39%) out of all studied patients achieved poor recovery. The injured nerves, that were preserved in continuity, acquired by a low-energy trauma, and treated earlier than the 6 months were associated with better functional outcome following the surgery. In addition, there was a trend of better functional improvement with aging, keeping in mind that the old were subjected to lower energy trauma. The expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury. The energy of trauma may be a factor predicting patient's final recovery following the treatment.

Approach to Humeral Shaft Nonunion: Evaluation and Surgical Techniques.

Humeral shaft fractures account for 1% to 3% of all fractures. Traditional nonsurgical treatment with a functional brace is still the standard treatment of these fractures; however, modern studies have reported that nonunion rates may be as high as 33%. Recent information suggests that the development of nonunion after nonsurgical treatment may be identified as early as 6 to 8 weeks postinjury. Even with surgical treatment, nonunion rates as high as 10% have been reported. Regardless of the original treatment method, nonunion results in poor quality of life for the patient and therefore should be addressed. A thorough preoperative evaluation is important to identify any metabolic or infectious factors that may contribute to the nonunion. In most cases, surgical intervention should consist of compression plating with or without bone graft. Although most patients will achieve union with standard surgical intervention, some patients may require specialized techniques such as cortical struts or vascularized fibular grafts. Successful treatment of humeral shaft nonunion improves function, reduces disability, and improves the quality of life for patients. In this article, we outline our approach to the treatment of humeral shaft nonunion in a variety of clinical settings.