Humeral Shaft Fractures Research Articles

Predictors of traumatic nerve injury and nerve recovery following humeral shaft fracture.

Nerve palsy is common after humeral shaft fracture, with the radial nerve being the most commonly injured nerve. Isolated nerve injuries usually recover spontaneously, and operative intervention is rarely indicated. Our goal was to study the predictors of traumatic nerve injury and recovery in a large cohort of patients with humeral shaft fractures. A total of 376 patients with humeral shaft fracture, including 96 patients with documented traumatic nerve palsy and 280 with intact neurovascular examination on presentation, were retrospectively included in the study. The primary outcome was incidence of a traumatic nerve palsy, and the secondary outcome was nerve recovery. Nerve palsy was present in 96 patients (25.5%) at the time of injury. Radial nerve was the most commonly injured nerve (93.6%), followed by the ulnar (5.1%) and axillary (1.2%) nerves. Seventeen patients (17.7%) had multiple nerves palsies. A multivariable regression analysis revealed that the concomitant vascular injury (odds ratio [OR] 52, 95% confidence interval [CI] 5.6-480.6), distal one-third fractures (OR 6.3, 95% CI 2.7-14.7), and middle one-third (OR 2.8, 95% CI 1.2-6.5) vs. proximal fractures, open fracture (OR 2.1, 95% CI 1.1-4.4), and high-energy trauma (OR 1.7, 95% CI 1.1-2.9) were independent predictors of nerve palsy. Iatrogenic nerve injury was detected in 7 patients (4.6%), all affecting the radial nerve. Spontaneous recovery of traumatic nerve injuries was detected in 87 patients (91%), with 19% partial and 72% complete recovery. The initial sign of recovery was observed at median times of 7 and 9 weeks for those managed conservatively or fracture fixation. Operative treatment of the fracture had no effect on the outcome of nerve recovery (88.5% vs. 100%, P = .14). Ten patients (14.1%) had transected nerves at the time of exploration and open fractures (22.7% vs. 6.8%, P = .04), and concomitant vascular injury (33.3% vs. 7.3%, P = .02) were associated with nerve transection, portending a worse prognosis for nerve recovery compared with nerves in continuity (40% vs. 95.3%, P = .004). The incidence of nerve injury after humeral shaft fracture was 25%, reflecting an abundance of high-energy and open injuries in this cohort. Ninety-one percent of patients experienced improvement in their nerve function with a median time to recovery of 7-9 weeks. Operative treatment of the fracture did not change the rate of nerve recovery. Patients with multiple nerve palsies and concurrent vascular insult had worse nerve recovery. We recommend nerve studies if no sign of recovery is observed by 9 weeks.

Primary radial nerve palsy associated with humeral shaft fractures according to injury mechanism: is early exploration needed?

Radial nerve palsy is a common complication associated with humeral shaft fractures. The purposes of this study were (1) to evaluate the status of primary radial nerve palsy in patients with humeral shaft fracture according to injury mechanism, (2) to estimate the risk factors of primary RNP, and (3) to evaluate whether early exploration is helpful for radial nerve recovery. This study analyzed 162 patients with humeral shaft fractures from January 2014 to December 2019. All patients were surgically treated in our hospital. Of these, 109 high-energy injuries were identified and compared with 53 low-energy injuries. The risk factors of radial nerve palsy were analyzed, and the prevalence of radial nerve palsy and status of radial nerve exploration according to injury mechanism were evaluated. Nerve recovery rate according to early nerve exploration was investigated. There were 31 cases of radial nerve palsy among 162 patients: 27 in the high-energy humeral shaft fracture group and 4 in the low-energy humeral shaft fracture group. Logistic regression analysis for risk factors showed that the injury mechanism was significantly associated with primary radial nerve palsy. Among 31 radial nerve palsy patients, 21 radial nerves were explored and 19 radial nerves recovered completely (80.6%). In the high-energy humeral shaft fracture group, 18 radial nerves were explored during surgery among 27 radial nerve palsy cases, and 16 cases recovered (88.9%). The other 9 radial nerves were not explored, and only 5 cases recovered (55.6%). This study confirmed that the incidence of radial nerve paralysis was higher in high-energy humeral shaft fractures than in low-energy fractures. The more common fracture patterns were oblique, transverse, wedge, and comminuted in high-energy humeral shaft fracture. This study suggests that these patterns are not directly associated with radial nerve palsy, but that high-energy injury is associated with a specific fracture pattern. Early nerve exploration during surgical treatment in patients with radial nerve palsy associated with humeral shaft fracture was helpful especially after high-energy injury.

Alternative and off-label use of Titanium Elastic Nail® in acute adult humeral diaphyseal and subcapital fractures

Traumatic adult humeral diaphyseal fractures can be difficult to deal with in geriatric patients. Three examples are summarized in using Titanium Elastic Nails® (TEN) in adult patients as an efficient alternative and an off-label strategy in treating diaphyseal as well as subcapital humeral fractures. A 75 years old adult female patient suffering from a motor neuron disease with flail arm syndrome and symmetric limp paraparesis of the arms with missing reflexes of arms and legs. Plain film radiographs demonstrated a multifragmentary fracture of the diaphysis of the right humerus with slight dislocation. After fail of an initial conservative therapy attempt, the fracture was splinted intramedullary with two titanium elastic nails until fracture healing. A 59 years old female patient slipped and fell at ground level on her left side. An oblique diaphyseal humeral fracture was found. Due to an anticoagulation with clopidogrel and a major rotator cuff lesion an immediate operation was performed by minimally invasive intramedullary titanium elastic nailing. Two and a half months after surgery the fracture was fully consolidated, full weight bearing was possible four months after the surgery. The implant removal was performed five and a half months after the initial trauma without postoperative complications with full recovery of the patient and restitutio in integrum. A young female skier fell on the ski field and sustained a subcapital humerus fracture on the left side. As a primary wish of the patient getting the most minimally invasive and scar free operation, an off-label use of Titanium Elastic Nail® (TEN) was chosen and performed. The postoperative stability did allow an adequate early functional training with initially passive and active assistive motion. In conclusion, intramedullary titanium elastic nailing can be a sufficient minimally invasive technique in patients with secondary diagnoses influencing operability, bone structure and fracture healing.

The risk of iatrogenic radial nerve and/or profunda brachii artery injury in anterolateral humeral plating using a 4.5 mm narrow DCP: A cadaveric study.

Fixation of humeral shaft fractures with a plate and screws can endanger the neurovascular structure if proper care is not taken. No studies to our knowledge have studied the risk of iatrogenic radial nerve and/or profunda brachii artery (RNPBA) injury from each screw hole of a 4.5 mm narrow dynamic compression plate (narrow DCP). The purpose of this study is to evaluate the risk of RNPBA injury in anterolateral humeral plating with a 4.5 mm narrow DCP. 18 humeri of 9 fresh-frozen cadavers in the supine position were exposed via the anterolateral approach with 45 degrees of arm abduction. A hypothetical fracture line was marked at the midpoint of each humerus. A precontoured ten-hole 4.5mm narrow DCP was applied to the anterolateral surface of the humerus using the fracture line to position the center of the plate. All screw holes were drilled and screws inserted. The cadaver was then turned over to the prone position with 45 degrees of arm abduction, and the RNPBA exposed. The holes through in which 100% of the screw had contact with or penetrated the RNPBA were identified as dangerous screw holes, while lesser percentages of contact were defined as risky. The relative distance ratios of the entire humeral length from the lateral epicondyle of the humerus to the 4th, 3rd, 2nd and 1st proximal holes were 0.64, 0.60, 0.56 and 0.52, respectively. The most dangerous screw hole was the 2nd proximal, in which all 18 screws had contacted or penetrated the nerve, followed by the risky 1st (12/18), 3rd (8/18) and 4th (2/18) holes. In humeral shaft plating with the 4.5mm narrow DCP using the anterolateral approach, the 2nd proximal screw hole carries the highest risk of iatrogenic radial nerve and/or profunda brachii artery injury.

Humeral Shaft Fracture Sustained During Arm Wrestling with Review of Factors Contributing to its Causation.

Introduction:Humeral shaft fractures are the most common injury sustained in arm wrestling, and its various biomechanical, anatomical, kinematic and electromyographic aspects have been studied and reported. We present a series of six cases of humeral shaft fractures in the arm wrestlers and a review of basic science studies to determine the factors contributing to their causation.Materials and methods:Six humeral shaft fractures associated with arm wrestling were treated between December 2018 and January 2020. The medical records and radiographs were retrospectively reviewed. In addition, the characteristics of the patients, their opponents, and the fractures were noted in a pre-designed data sheet.Results:There were six men with an average age of 27.5 years (SD ± 8.9). All were amateurs who were occasional arm wrestlers. Three fractures each were sustained in the sitting and standing position, four in the losing phase, one in the winning phase, and one in the stalling phase. The dominant side humerus was involved in all but one case. The fracture types were 12-A1 (n=4); 12-B1 (n=1); 12-A2 (n=1). Three fractures were treated by open reduction and internal fixation, while three were treated conservatively with satisfactory healing.Conclusion:Humeral shaft fractures in arm wrestling are common in amateurs. There is no association of the fracture with the position of the players or the phase of the match. However, arm wrestlers should be aware of this complication and should receive proper guidance to reduce the risk of humeral shaft fractures.

Assessment of Shoulder Function after Internal Fixation of Humeral Diaphyseal Fractures in Young Adults: A Prospective Comparative Study.

Background Humeral shaft fractures are commonly encountered in casualties. There are different methods of operative internal fixation with no consensus on the best technique. The objective of this study was to assess shoulder function and rate of complications among two different options of fixation, intramedullary nailing, and minimal invasive plate osteosynthesis (MIPO) in young adults. Methods Forty-two patients with humeral shaft fractures were included in the study and divided into two equal groups: group A treated with antegrade intramedullary locked nails (IMN) and group B with MIPO. Fracture union was evaluated with serial X-rays, and shoulder function was assessed in both groups using the scale of the American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles Shoulder Scale (UCLA), and visual analog score (VAS). The mean differences between groups were recorded and considered significant if the P value was ˂0.05. Results The results were reported prospectively with no significant differences in mean age, sex, side of injury, type of fracture, mechanism of injury, and the follow-up period between the groups studied. Group A had shorter operative time and minimal blood loss than group B. Regarding shoulder function scores (ASES, UCLA, and VAS), the results in the MIPO group were better than the IMN group with shorter time of union and fewer complications. Conclusion Despite a shorter operative time and lower blood loss during locked intramedullary nail fixation in the management of humeral shaft fractures, MIPO enables more superior shoulder function with better fracture healing and lower morbidities.

Anterior Bridge Plate Osteosynthesis in Comminuted Fracture Shaft of Humerus in Manual Workers- is it Optimum Choice?

Bridge plate osteosynthesis of fractures by minimal invasion and near acceptable reduction is becoming popular and acceptable entity. Management of humeral shaft fracture has evolved a lot with their pros and cons. Anterior bridge plate osteosynthesis (ABPO) for humeral shaft fracture is pertinent to a minimal invasive procedure, and it has evolved as a new entrant in the surgical techniques. This study was designed to carry out the results and efficacy of ABPO in the comminuted fracture shaft of the humerus in the manual workers. Study included the closed comminuted fracture of shaft of humerus in skeletally mature patients engaged predominantly in manual works, like overhead sports activity, laborers, and industrial workers. All fractures were managed by either 4.5-mm narrow locking compression plate (LCP) or dynamic compression plate (DCP).The functional outcome for elbow was measured by Mayo's elbow performance score (MEPS) and functional outcome of shoulder was measured by UCLA (University of California at Los Angeles) shoulder score system. In this study 37 patients were enrolled. Mean duration for satisfactory radiographic union was 12.3 weeks. The mean duration of follow-up period was 14.5 months. In respect to elbow function, the average Mayo elbow score was 92.42 ±2.17 and average UCLA score of shoulder function was 34 ±0.34. The ABPO is an optimum choice for managing the comminuted fracture shaft of humerus in manual labors. The outcomes are favorable and reproducible with very few risks.

A study of functional outcome of humeral shaft fracture treated with anterior bridge plating

A study of functional outcome of humeral shaft fracture treated with anterior bridge plating

Humeral shaft fracture associated with radial nerve palsy -a case report

Radial nerve palsy was induced by radial nerve compression, which was often caused by humerus bone fracture. This leads to pain, weakness, or loss of function mostly in the wrist, hand, and fingers. We reported a case of a 24-year-old male patient with complaints of swelling of the right-hand wrist joint and pain during extension and flexion while moving. He had a three-month history of mild displaced humeral shaft fracture from a traffic accident and an intramedullary Ender nailing was performed. He now has been admitted with swelling in his right wrist joint and pain while moving his hand. The case was diagnosed as Radial nerve palsy. Surgery was performed, the proximal and distal ends of the radial nerve were separated at the humeral bone's surface. The radial nerve stumps were enough long to be sutured. Our one-month follow-up shows no complications. The majority cases of radial nerve palsy will resolve within a few weeks after surgery, as our patient did, and the most prominent is patient education.

Effect of Minimally Invasive Percutaneous Bone Plate Internal Fixation Combined With Jintiange Capsule in the Treatment of Humeral Shaft Fracture and Its Effect on Postoperative Trauma Index and Bone

Effect of Minimally Invasive Percutaneous Bone Plate Internal Fixation Combined With Jintiange Capsule in the Treatment of Humeral Shaft Fracture and Its Effect on Postoperative Trauma Index and Bone

Use of patient reported experience measure and patient reported outcome measures to evaluate differences in surgical or non-surgical management of humeral shaft fractures.

The aim of this study was to evaluate the use of patient reported experience measures (PREMs) in humeral shaft fractures managed with or without surgery against patient reported outcome measures (PROMs). Adult patients treated for a humeral shaft fracture between June 2015 and August 2017 were included in non-surgery and surgery (early and late surgery) groups. The PREM questionnaire was based on patient and clinician feedback obtained during focus groups and was posted to patients. PROMs included the short form-12 (SF-12) and visual analogue scale (VAS) for pain, stiffness, function and satisfaction. Eighty-one patients responded, 54 patients were treated in a brace and 27 with surgery (13 early, 14 late). There was moderate positive correlation between PREM and VAS satisfaction and function and moderate negative correlation with VAS pain and stiffness. There was also moderate positive correlation between PREM and SF-12 mental and weak positive correlation with SF-12 physical. The late surgery group had poorer PREMs (expectations, p = 0.002 and friends & family test, p = 0.0001) and PROMs (VAS satisfaction, p = 0.005) compared to the early surgery group. PREMs can be used in conjunction with PROMs to improve the patient's quality of care and as a means of identifying, at an early stage, those patients not doing well and to offer surgery.

Beware the rebound effect: regional anesthesia increases opioid utilization after humerus fracture surgery.

Regional anesthesia (RA) is used reduce pain in proximal humerus and humeral shaft fracture surgery. The study hypothesis was that RA would decrease opioid demand in patients undergoing fracture surgery. Opioid demand was recorded in all patients ages 18 and older undergoing proximal humerus or humeral shaft fracture surgery at a single, Level I trauma center from 7/2013 - 7/2018 (n = 380 patients). Inpatient opioid consumption from 0-24, 24-48, and 48-72 h and outpatient opioid demand from 1-month pre-operative to 90-days post-operative were converted to oxycodone 5-mg equivalents (OE's). Unadjusted and adjusted models were constructed to evaluate the impact of RA and other factors on opioid utilization. Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.8 estimated OE's without RA vs 8.8 estimated OE's with RA from 0-24 h post-op; 10 vs 13.7 from 24-48 h post-op; and 8.7 vs 11.6 from 48-72 h post-op; all p < 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at all timepoints. In proximal humerus and humeral shaft fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics.

One-year follow-up after treatment of proximal and/or middle one-third humeral shaft fractures with a helical plate: healing rates, complications and functional outcome measures

BackgroundConventional plate osteosynthesis is a valuable treatment option in displaced proximal and/or middle one-third humeral shaft fractures. Nonetheless, this procedure can be complicated by a radial nerve palsy. To date, many surgical techniques have been developed in an attempt to minimize this high-impact complication. A helical plate has the potential to avoid an iatrogenic radial nerve palsy due to its design. This article aims to evaluate safety and functional outcomes of patients treated with a helical plate compared to conventional plate osteosynthesis. In particular healing rates, complications and functional outcome measures.MethodsWe retrospectively included all patients with displaced proximal and/or middle one-third humeral shaft fractures who were treated with a helical plate from October 2016 until August 2018 at a single level-1 trauma center (AZ Groeninge, Kortrijk, Belgium). A self-molded long PHILOS plate (DePuy Synthes®) or a pre-contoured A.L.P.S proximal humeral plating system (Zimmer Biomet®) were used. Patient baseline characteristics and standard radiographs were obtained pre- and postoperatively. We retrospectively searched for complications. Patients were reassessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley (CMS) and EQ-5D-5L scores with a minimal follow-up of 1 year.ResultsThe humeral shaft fractures of all sixteen patients consolidated within 3 months and no iatrogenic radial nerve palsies were observed. One plate had to be removed after 1 year due to a late deep infection. With a minimum follow up of 1 year, the mean DASH score was 22 ± 19 and the mean normalized CMS was 80 ± 19.ConclusionOperative treatment of proximal and/or middle one-third humeral shaft fractures with a helical plate is a safe procedure with good to excellent shoulder function at one-year follow-up. Contrary to conventional plate osteosynthesis, a helical plate has the potential to completely avoid a radial nerve palsy, while maintaining similar healing rates and functional outcomes.Trial registrationRetrospective cohort study. B396201939564. Registered on 10 MAY 2019.

Comparison of Expandable and Locked Intramedullary Nailing for Humeral Shaft Fractures.

IntroductionIn this study, we clinically and radiologically investigated whether the application of expandable nails for surgical treatment of humeral shaft fractures has an advantage over locked intramedullary nails.MethodsPatients treated with intramedullary fixation due to humeral shaft fractures in our clinic were investigated retrospectively. Patients with fractures of type 12A and 12B according to the AO classification in the middle 1/3 shaft region of the humerus were divided into two groups as those receiving fixation with expandable nails and with locked intramedullary nails. The union rate, union time, Q-DASH scores, duration of surgery, and complication rates were statistically compared between the two groups.ResultsThe study included 38 patients with clinical follow-up from among 47 patients; 20 patients received fixation with locked intramedullary nails and 18 with expandable nails. The mean age of the patients was 56.92 (19-91) years and 53% (n=20) were men while 47% (n=18) were women. During statistical evaluation, a statistically significant difference was found between the groups for union (100% and 72.2%) and complication rates (6% and 13%). More union and lower complication rates were found in patients treated with locked intramedullary nails. In comparing the mean of surgical times (71.1 and 30.2 min), expandable nails had a shorter surgical time. However, there was no statistically significant difference between the union time and Q-DASH scores between the two groups.ConclusionLocked intramedullary nails are a better fixation method than expandable nails due to the low complication rate and high rate of union. However, due to shorter surgery time, expandable nailing is an alternative method in limited cases.

Prevalence and risk factors for pseudarthrosis in humeral shaft fractures treated by minimally invasive plate osteosynthesis: A 10-year review.

Fractures of the humeral shaft account for about 3% to 5% of all fractures. Although conservative treatment remains the first choice, there are a number of surgical indications. Minimally invasive plate osteosynthesis shows good functional results. However, complications have been reported, such as non-union. To assess the prevalence and risk factors for non-union after treatment of humeral shaft fractures using minimally invasive plate osteosynthesis. This retrospective study was carried out in patients treated by minimally invasive plate osteosynthesis between 2009 and 2019. Demographic data and variables related to the fracture that could influence bone healing were analysed. The unpaired t-test and Mann-Whitney test were used for the statistical analyses. Categorical variables were analysed using the chi-square test or Fisher's exact test. The study population showed a male predominance (53 of 75, 70.7%). The average time for fracture healing was 19.8 ± 15.3 weeks. Seven patients developed non-union. Only the presence of an open fracture increased the likelihood of non-union. The prevalence of non-union in patients treated by minimally invasive plate osteosynthesis was 9.3%. Patients with open fractures were six times more likely to progress to non-union. Fracture characteristics (Arbeitsgemeinschaft für Osteosynthesefragen classification, fracture location and plate working length) did not influence progression to non-union.

Anterior bridge plating with mini incision MIPO technique for type a humerus diaphyseal fractures

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow- up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.Materials and Methods: Twenty patients with type a 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 closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10–16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score.Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.

A study of clinico-radiological outcomes of diaphyseal humerus fracture treated with minimal invasive plate osteosynthesis (MIPO)

Introduction: Humeral shaft fracture is one of the common injuries encountered in orthopedic surgery accounting for 1% - 5% of all fractures. Although nonoperative treatment of humeral shaft fracture is associated with satisfying clinical and functional outcomes in most cases, usually results in varus deformity and limitation of shoulder and elbow motion in some patients. Thus, orthopedic surgeons prefer operative management due to early return to function and low compliance of the patients. Materials and Methods: 29 patients with diaphyseal fractures of the humerus treated with MIPO between January 2015 and June 2016 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 2 and 3 open fractures were excluded from the study. All patients having diaphyseal humerus fracture were treated with closed indirect reduction and plate fixation 4.5 dynamic compression plate using the MIPO technique. The surgery time, and time for union was noted. The shoulder and elbow function were assessed using the UCLA shoulder and Mayo elbow performance scores, respectively in follow up examination. Results: Of the 32 patients in the study, 16 were males and 13 were females. The mean age was 34.5 years (Range: 18-58 years). Twenty of the twenty nine patients had the dominant side fractured. We had six cases of C1 and A2 type; three cases of A1, B2 and C3 type; four cases of B1 type; two cases of C3 type; and one case of A3 and C2 type of fracture. The mean surgical time was 93.1 minutes (range: 70–120 minutes). The mean radiological fracture union time was 13.1 weeks (range: 10–18 weeks). Shoulder function was excellent in 24 cases (82.7%) and good in remaining 5 cases (17.3%) on the UCLA score. Elbow function was excellent in 25 cases (86.2%) and good in 4 cases (13.8%) on mayo elbow performance score. 2 patients developed radial nerve palsy and translation was present in 4 patients. Conclusion: In diaphyseal humerus fracture, MIPO gives good functional and cosmetic result and this should be considered as one of the good option in treatment of diaphyseal humerus fracture.

Predicting the Behavior of Humeral Shaft Fractures: An Independent Validation Study of the Radiographic Union Score for HUmeral Fractures and Value of Assessing Fracture Mobility.

To externally validate the Radiographic Union Score for HUmeral fractures (RUSHU) and to quantify the predictive relationship of fracture motion on physical examination to nonunion. Retrospective cohort study. Single institutional center (University teaching hospital). Ninety-two consecutive patients undergoing nonoperative treatment of a diaphyseal humeral shaft fracture were identified over a 4-year period. The average age of the population was 62 years and 42% of the cohort was men. Clinical examination for fracture stability was routinely performed on patients by the treating physicians. Radiographic assessment of fracture callus (RUSHU score) at 6 weeks was retrospectively determined. Patients were followed up until union. Stability was graded as motion at the fracture site or the humerus moving as a single functional unit. Fractures with a RUSHU score ≤7 were 14 times more likely to proceed to nonunion at 6 months (78% sensitivity, 80% specificity). The time to union was 49 weeks for a RUSHU score of ≤7 versus 16 weeks for a RUSHU score of ≥8. The number of operations needed to avoid one nonunion was 1.7. Fractures mobile at 6 weeks were 6.5 times more likely to proceed to nonunion at 6 months (77% specificity, 67% sensitivity). Mobile fractures had a longer time to union (41 weeks) than nonmobile fractures (17 weeks). The RUSHU score and clinical assessment of fracture mobility are effective and valid tools in identifying patients at risk of developing nonunion of humeral shaft fractures and can enhance early decision making in fracture management. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Close enders nailing as internal bracing for acute humeral diaphyseal fractures in children and adolescents

Background: In children diaphyseal fractures of humerus are most commonly treated by close reduction and cast immobilisation. Surgical treatment is preferred only in the cases recalcitrant to conservative treatment (1). Aim of the study: The present prospective study is to analyse the functional outcome of close enders nailing in the management of diaphyseal fracture of humerus in children and adolescents Material and Methods: Thirty patients with diaphyseal fracture of humerus in children and adolescents were treated with close enders nailing. In our series, mean age of the patients was 13.05 years (10 to 16 year).Boys dominated our series (n=20 i.e.66.66%) and right side (n=22 i.e.73.33%) was more commonly involved in both sexes. All the fractures were stabilised with close reduction and internal fixation with antegrade Enders nailing. Result: Minimal follow up was six month. Timely union was observed in all except three in an average of 10.81 weeks. In two cases union was delayed (14 and 16 weeks). One case faced nonunion and was treated with open reduction and internal fixation with dynamic compression plate with bone grafting.Observation: Functional outcome was evaluated using DASH Score. We had 27 excellent, 02 good and 01 poor result in our series. Conclusion: Close enders nailing is very demanding, safe and efficient method of treatment of acute humeral diaphyseal fracture in children and adolescents, offers a biological method of fracture healing and can be considered as internal bracing(2). Level of evidence – IV (case series).

Efficacy of dynamic compression plating (DCP) in treating adults with humerus shaft fractures

Introduction: Fractures of the humerus shaft accounts about 3 to 6% of all fractures of which majority can be managed by conservative management but some will require surgery. The objective and aim were to determine the efficacy of dynamic compression plate (DCP) in the treatment of humeral shaft fractures in adults. Materials and Methods: This was a prospective study of 20 cases of fracture shaft of humerus admitted to Navodaya Medical Hospital and Research Centre, Raichur between December 2019 and October 2021. Cases were taken according to inclusion and exclusion criteria, with written informed consent. The study was approved by the Ethical committee of the institute.Results: Out of 20 cases, there were 14 (70%) men and 6 (30%) women. 15 (75%) cases were admitted due to Road Traffic Accident and 5(25%) had fall at home. Of 20 cases, 2 cases (10%) were proximal third, 14 (73%) were middle third, and 4 (20%) were distal third. Short oblique fractures or Transverse were commonly found. The fractures united in 18 (90%) patients, with 2 (10%) cases showed delayed union due to deep infection. Good range of mobility of shoulder and elbow joints was present in 18 (90%) patients, with 2 (10%) patients having poor mobility.Conclusion: Open reduction and Internal fixation of the humerus shaft fractures treated with dynamic compression plate provides higher union rates as compared to other modes of treatment available.