Diaphyseal Fractures Of Humerus Research Articles

Type I Monteggia Fracture with Associated Ipsilateral Capitellar and Humeral Diaphyseal Fractures in an Adult

Background: Monteggia fractures entail a proximal ulnar fracture with associated radial head dislocation. Primarily observed as a fracture in the pediatric population, there have been rare occurrences in adults. In rare instances, various associated fractures have been reported with Monteggia fractures. However, during our literature review, a type I Monteggia fracture had not been reported along with ipsilateral diaphyseal humerus and capitellar fractures. Here, we present a successful post-operative outcome for a unique fracture distribution and form of fixation that has yet to be reported in the literature.

Dynamic Compression Plating Versus Antegrade Intramedullary Nailing for the Treatment of OTA/AO 12-A Fractures: A Retrospective Cohort Study.

Fractures of the humerus diaphysis are common and often result from motor vehicle accidents (MVAs). Treatment methods range from nonoperative approaches to various operative techniques, including antegrade intramedullary nailing (AIMN) and dynamic compression plate (DCP) fixation. This study aimed to compare the cost effectiveness and outcomes of plating and nailing for humerus diaphyseal fractures. A retrospective cohort study involving 59 cases of humerus diaphyseal OTA/AO 12-A fractures was conducted at King Saud Medical City (KSMC), a level I trauma center located in the center region in Riyadh, Saudi Arabia. Patients treated with AIMN, anterolateral plating, or posterior plating were included. Data on demographics, clinical parameters, radiographic healing, and costs were collected and analyzed. The average surgical duration was shorter in the AIMN group compared to the anterolateral and posterior plating groups but with no statistical significance (P > 0.05). The average length of stay (LOS) was shorter, and the change in hemoglobin levels was lower in the AIMN group when compared to other groups but without a statistically significant difference (P > 0.05). The average cost of AIMN was significantly higher than that of anterolateral and posterior plating groups (P < 0.0001). While both nailing and plating procedures are options for treating OTA/AO 12-A fractures, AIMN carries a higher overall procedural cost. The practice of drain placement in our study population is likely the cause of the increased LOS in the plating groups. Relative additional analgesic requirements were associated with AIMN. Surgeons should consider meticulous hemostasis to avoid drain placement, which can decrease LOS, thus possibly decreasing unnecessary treatment costs of humerus shaft fractures.

COMPARATIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT OUTCOMES IN PATIENTS WITH DIAPHYSEAL HUMERUS FRACTURES

The frequency of diaphyseal humerus fractures varies from 1% to 5% of the total number of skeletal fractures in humans. A clear bimodal gender and age distribution of patients with fractures in the studied area has been established. The main methods of treatment for closed intra-articular humerus fractures are conservative functional and surgical treatment. Treatment of diaphyseal humerus trauma involves not only restoring the axis and length of the bone but also ensuring sufficient mobility of adjacent joints. The aim of the study was to conduct a comparative analysis of the outcomes of conservative and surgical treatment in patients with diaphyseal humerus fractures. The study involved 57 patients with diaphyseal humerus fractures aged from 19 to 83 years. The first clinical group comprised of 24 patients aged from 24 to 80 years who were treated using functional fixation devices. The second clinical group consisted of 33 patients aged from 19 to 83 years who were treated using surgical techniques, namely antegrade locked intramedullary nailing and cortical plate and screw osteosynthesis. Rehabilitation measures were initiated within the first two days for patients in the first group and in the early postoperative period for patients in the second group. The range of motion of adjacent joints was assessed using the CMS and MEPS scales. The use of surgical treatment techniques in combination with early rehabilitation measures, compared to conservative functional treatment, allows achieving significantly higher and statistically significant (p&lt;=0.01) functional outcomes of elbow joint mobility.

Modified medial minimally invasive double-plating osteosynthesis techniques for the treatment of distal third diaphyseal fracture of humerus

The optimal surgical approach and placement of plates for the treatment of distal third diaphyseal fracture of the humerus are the subjects of debate. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of modified medial minimally invasive plate osteosynthesis (MIPO) techniques using a double technique for the treatment of distal third diaphyseal fracture of the humerus. A total of 30 patients with a distal third diaphyseal fracture of the humerus were selected from our hospital. Patients were seen between January 2017 and October 2022. They were treated with a modified medial approach combined with MIPO using a double plate technique. Patient demographics, operation time, bleeding volume, union time, complications, the mean fracture length (FL) and distal cortical length (DCL), and the number of screws in the distal fragment were analyzed. The function of the shoulder and elbow was evaluated using Neer’s assessment of the shoulder and Mayo’s assessment of the elbow. The FL was 56.1 ± 7.2 mm and the DCL was 38.3 ± 5.3 mm. The mean operative time was 84.8 ± 13.4 min (range 60–110 min). The mean blood loss during surgical treatment was 46.5 ± 10.2 ml (range 30–60 ml). Bone healing was observed in all patients from 10 to 16 weeks (average 12.1 ± 1.7) postoperatively, and one case with poor surgical wound healing was recorded. All the patients had good function of both the shoulder and elbow. The maximum flexibility of the elbow ranged from 130° to 145° (average 138.1 ± 4.8°), with a maximum flexibility straightness ranging from 0° to 5° (average 2.2 ± 1.3°). The Mayo elbow joint function score was 80–100 (average 91.4 ± 5.0). The Neer shoulder joint function score ranged from 85 to 100 (average 92.5 ± 3.9). The modified medial approach was beneficial it did not cause any iatrogenic radial nerve or ulnar nerve injuries. The anterior and the medial side plates are fixed perpendicular to the distal humerus and provide excellent stability at the same time producing better shoulder and elbow joint function.

An alternative osteosynthesis technique: single column anatomical plate fixation for distal humerus diaphyseal fractures

Background: The treatment of distal humerus diaphyseal fractures presents significant challenges for orthopedic surgeons. The goal of this study is to evaluate the effectiveness and outcomes of a single column anatomical plate as an alternative method of osteosynthesis for fixing distal humerus diaphyseal fractures. Methods: A Prospective analysis of patients who underwent surgery for distal humerus diaphyseal fractures at a tertiary care medical center was conducted. Patients who received treatment using a single column anatomical plate were included in the study. Preoperative, intraoperative, and postoperative data, including fracture type, surgical approach, complications, range of motion, and radiographic outcomes, were collected and analyzed. Results: Type B2 fractures were more common in our study i.e., 80%. The maximum incidence was between 18 to 59 years i.e., 21 cases (77%). Average radiological union was seen at 15 weeks. This study shows Excellent outcome in 67% and Good in 30% of patients. Average post-operative ROM at 1 year was mean flexion 120°(SD 7), mean extension of 6 degrees (SD 4.7), mean pronation 81.25°(SD 2.5) and mean supination 82.5°(2.8). Average MEPS score was 95.5 at 1 year. The mean metaphyseal-diaphyseal angle was 85°, the mean humeral-ulnar angle was 14°, which was within the normal limits. Conclusion: The use of a single column anatomical plate for fixing distal humerus diaphyseal fractures appears to be a promising alternative method of osteosynthesis. However, further prospective studies with larger sample sizes and longer follow-up periods are warranted to validate the efficacy and safety of this technique.

The comparison of functional bracing of humeral shaft fractures: thermoplastic custom against preprepared commercial braces

Functional humeral bracing of midshaft humeral fractures has been widely accepted as a gold standard for nonoperative treatment. Despite reported high union rates, there is no proven superiority of any orthosis. Here we aim to compare the outcomes after the use of custom-made thermoplastic vs. commercial humeral brace with regard to time to union, nonunion rates, types of nonunion, and conversion to surgery. Patients with humeral fractures treated between 2018 and 2021 were identified retrospectively by electronic records. Only diaphyseal humerus fractures (AO 12) were included in the study. Proximal (AO 11) or distal (AO 13) fractures, open fractures, pathologic fractures, bilateral fractures, multiple fractures, and patients lost to follow-up were excluded. Patients attending one center received a custom-made thermoplastic splint, whereas those at the other center had an off-the-shelf humeral brace applied. Radiologic union was defined as healing of at least 3 of 4 cortices determined from follow-up radiographs. Data calculations were performed using the χ2 test. A total of 53 patients treated with a thermoplastic brace and 43 with a commercial brace were identified. A total of 52 men were included, and the cohort's mean age was 60.1 years (standard deviation: 16.1 years). Both groups had similar gender and age distributions. More patients achieved union with a thermoplastic brace (79.2%) than those with a commercial brace (76.7%), which was statistically significant (χ2, P=.04). Although time to union was similar both clinically and radiologically, patients with a commercial brace converted to surgical treatment more frequently (11 vs. 14 cases). Thermoplastic custom-made braces provide better fracture stability, allowing for statistically significantly higher rates of fracture union during a similar treatment period to commercially available splints. Patients wearing a commercial splint were significantly more likely to develop hypertrophic nonunion requiring surgery.

Proximal fracture line extension in humeral shaft fractures

IntroductionHumeral shaft fractures are common injuries treated by orthopaedic surgeons. The purpose of this study is to evaluate displaced diaphyseal humerus fractures and describe the incidence and characteristics associated with non or minimally displaced fracture line extension into the proximal metadiaphyseal region of the humerus. Methods and materialsAll adult patients with diaphyseal humeral shaft fractures located within the distal two-thirds of the humeral shaft, treated at a single level I trauma institution between 2007 and 2020, were retrospectively identified. 202 patients with 203 fractures of the humeral shaft were included. Fracture patterns were classified according to AO/OTA classification and fracture line extension into the proximal metadiaphyseal region was evaluated on radiographs. Patient demographics, management details, and radiographic outcomes were obtained from review of the electronic medical record. ResultsOf 203 diaphyseal humerus fractures, 11.8 % (n = 24) had non or minimally displaced proximal extension of their main fracture line. This included 43.7 % (n = 7) of all proximal third junction diaphyseal fractures, 10.7 % (n = 16) of all middle third diaphyseal fractures, and 2.6 % (n = 1) of all distal third diaphyseal fractures. Patients with proximal fracture extension were, on average, older (61.7 versus 44.4 years, p < 0.001), and a higher percentage were female (75 % versus 45.5 %, p < 0.01) compared to patients without fracture proximal extension. Fractures with proximal extension were all closed fractures (n = 24), were more often sustained from low-energy fall (87.5 % versus 35.2 %, p < 0.001), and were more often spiral type fractures (62.5 % versus 17.2 %). Fractures with proximal extension were more often treated non-operatively (58.3 % versus 42.1 %, p < 0.01), but were found to have a higher rate of nonunion after non-operative treatment (17.6 % versus 8.1 %) compared to fractures without proximal extension. All operatively treated fractures that had proximal metaphyseal extension were secured with a fixation construct to achieve fixation proximal to the extent of the fracture line, most often into the humeral head and neck. Operative management with proximal fixation into the humeral head was also pursued for a patient with nonunion, including persistent lucency of the proximal extension line, after failed non-operative treatment. Mean follow-up was 35.5 weeks (range: 0–607 weeks). ConclusionsProximal fracture line extension in the setting of diaphyseal humerus fractures is not uncommon. Detection and consideration of this sometimes subtle finding is important when planning to treat these injuries operatively.

Deep learning classification of shoulder fractures on plain radiographs of the humerus, scapula and clavicle.

In this study, we present a deep learning model for fracture classification on shoulder radiographs using a convolutional neural network (CNN). The primary aim was to evaluate the classification performance of the CNN for proximal humeral fractures (PHF) based on the AO/OTA classification system. Secondary objectives included evaluating the model's performance for diaphyseal humerus, clavicle, and scapula fractures. The training dataset consisted of 6,172 examinations, including 2-7 radiographs per examination. The overall area under the curve (AUC) for fracture classification was 0.89, indicating good performance. For PHF classification, 12 out of 16 classes achieved an AUC of 0.90 or greater. Additionally, the CNN model had excellent overall AUC for diaphyseal humerus fractures (0.97), clavicle fractures (0.96), and good AUC for scapula fractures (0.87). Despite the limitations of the study, such as the reliance on ground truth labels provided by students with limited radiographic assessment experience, our findings are in concordance with previous studies, further consolidating CNN as potent fracture classifiers in plain radiographs. The inclusion of multiple radiographs with different views from each examination, as well as the generally unselected nature of the sample, contributed to the overall generalizability of the study. This is the fifth study published by our group on AI in orthopaedic radiographs, which has consistently shown promising results. The next challenge for the orthopaedic research community will be to transfer these results from the research setting into clinical practice. External validation of the CNN model should be conducted in the future before it is considered for use in a clinical setting.

Radiological and functional outcomes of anterior bridge plating with minimally invasive plate osteosynthesis technique for humerus diaphyseal fractures in adults

Background: We conducted a study to evaluate radiological, functional outcomes and complications of internal fixation of humerus diaphyseal fractures by anterior bridge plating (ABP) with minimally invasive plate osteosynthesis technique. Methods: 40 patients with humerus diaphyseal fractures operated by ABP with MIPO between August 2017 and January 2020 were included in the study. All patients were evaluated verbally, clinically, and radiologically for a minimum of 1 year. Results: Mean time to radiological union was 13.75 weeks. Disabilities of the arm, shoulder and hand score improved from a mean of 23.45 to a mean of 5.04 at 6 months. All patients except one had an excellent Mayo Elbow Performance Score score at 6 months. The variation of mean shoulder range of motion between normal and operated side was within 5 degrees at 6 months. Visual Analogue Scale score improved from a preoperative mean of 8 to a postoperative mean of 0.5 at 6 months. Mean intraoperative blood loss was 147 ml. Two patients had a superficial wound infection, one patient had a postoperative radial nerve palsy, and one patient had a delayed union, all of which recovered without any surgical intervention. Conclusions: ABP with MIPO technique for humerus diaphyseal fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior patient satisfaction. Therefore, we recommend that ABP with MIPO should be considered as an alternative treatment option in patients with humerus diaphyseal fractures.

Chest wall soft tissue thickness is associated with humeral shaft non-union: A radiographic study

Background Anecdotally, upper truncal obesity and large breasts have often been associated with inferior outcomes from non-operative management of diaphyseal humerus fractures. However, this assertion is without basis in the literature. Aims To produce radiographic measurements of chest wall soft tissue thickness (STT) and determine association with non-union in diaphyseal humerus fractures. Methods Two hundred and seventeen consecutive non-operative humeral shaft fractures were included. Radiographic STT measurements were taken at three standardised points (upper, middle and lower) using a simple reproducible method, with ratios derived (dividing these figures by the mid-humerus diameter). Bivariate and multivariable analyses were used to assess association with non-union. Results There were 58 (26.7%) cases of non-union. On multivariable analysis, the middle (odds ratio (OR) 1.39, p &lt; 0.001) and lower (OR 1.23, p = 0.009) STT measurements were independently associated with non-union. Additionally, the middle (OR 1.85, p &lt; 0.001) and lower (OR 1.47, p &lt; 0.001) STT ratios were independently associated with non-union. A receiver operating characteristic curve determined a threshold value of a middle STT ratio of ≥ 3 (OR 3.73, p &lt; 0.001, sensitivity 69.0%, specificity 62.3%), which was independently associated with non-union. Conclusion Chest wall STT is independently associated with humeral shaft non-union. Threshold values can assist in decision making for these fractures.

Recovery of the Diaphyseal Fracture of the Humerus by Kinetic Means

The article presents the importance of the occurrence of diaphyseal fracture of the humerus, as a common fracture with a percentage of up to 3-5%, and their treated callus rate reaches the threshold of 67% to 98%. Inadequate treatment of humerus diaphyseal fracture contributes to stiffness and pain on movement, as well as deterioration of quality of life, which leads to surgical intervention. Traditionally, the intervention to treat this condition is based on closed reduction, but the causes that lead to surgical intervention are multiple: neurovascular injuries, prolongation of joint fractures, polytrauma, open fractures, pathological fractures, etc. The purpose of the article is based on highlight the importance of physical exercise in the recovery of humerus diaphyseal fractures. Thus, it can be used to monitor the patient's return to normal range of motion.

Preoperative estimation of humerus intramedullary nail length using clinical landmarks

PurposeIntramedullary interlocking nailing is one of the accepted methods of treating humerus diaphyseal fractures. Appropriate nail length and diameter are of paramount importance to achieve a stable fracture fixation. Estimating the nail length can be as challenging in certain cases as it is important. This study aims to provide an easy-to-use formula utilizing clinical measurements from contra lateral arm to accurately estimate humeral nail length. MethodsThis descriptive cross-sectional study was conducted at 3 tertiary care hospitals in Mangalore, India. Patients above the age of 18 years coming to the outpatient department with elbow, shoulder or arm complaints requiring radiological investigation from July 2021 to July 2022 were included. Patients with fractures or dislocations of upper limbs, malunited or non-united fractures of upper limbs, congenital or developmental deformities and patients with open growth plates were excluded. Patients’ variables (like age and gender), radiological humerus length and contralateral arm clinical measurements were recorded. An independent samples t-test was used for univariate analysis, and linear regression analysis was done to estimate the desired nail length using the clinical measurement of the humerus (cm) in both genders separately. The significance level was set at p < 0.05. ResultsOur study included 204 participants of which 108 were male and 96 were female. The formula for predicting humeral nail length in males is (−2.029) + (0.883 × clinical measurement). The formula for females is 1.862 + (0.741 × clinical measurement). A simplified formula to determine humeral nail length is 0.9 clinical length – 2 cm (in males) and 0.7 × clinical length + 2 cm (in females). ConclusionTo improve the stability of fixation with intramedullary nails it is imperative to select the appropriate nail length. There have been studies that devised reliable methods of determining nail lengths in the tibia and femur using preoperative clinical measurements. A similar clinical method of determining humeral nail length is lacking in the literature. Our study was able to correlate radiological lengths of the humerus medullary canal with clinical measurements performed using anatomical landmarks to arrive at a formula. This allows for a reliable and easy nail length determination preoperatively.

Comparative study between interlock nailing and dynamic compression plating in humerus diaphyseal fractures in its functional and surgical outcome

Background: The aim of the study was to analyse compare study between interlock nailing and dynamic compression plating in humerus diaphyseal fractures in its functional and surgical outcome. Methods: The 2019 to 2022, patients were randomly divided into two groups with the help of computer-generated coded envelopes, group A (humerus diaphyseal fractures treated with dynamic compression plating) and group B (humerus diaphyseal fractures treated with interlock nailing) with 20 patients in each group. Outcomes were evaluated based on operative time, blood loss, neurovascular deficit, surgical site infection, union, shoulder stiffness, constant Murley score, Mayo elbow performance index at 1 year of follow up. Results: On radiology as non-union and union, most common study participants show union, on follow up of 1 year constant Murley score and Mayo elbow performance index was calculated and constant Murley score was more in patients treated with dynamic compression plating, shoulder stiffness was more in patients treated with interlock nailing. However blood loss was more in patients treated with dynamic compression plating. Conclusions: The result of our study shows that interlock nailing is associated with less blood loss but it is associated with decreased shoulder function postoperatively and marked shoulder stiffness which is more than patients treated with dynamic compression plating. Hence dynamic compression plating should be considered gold standard for operative treatment of humerus shaft fracture.

A NOVEL THREE-STITCH TECHNIQUE FOR ANTEGRADE HUMERUS NAILING IN OPEN DIAPHYSEAL FRACTURES

To evaluate the functional outcome of open humerus diaphyseal fractures treated with the Three-stitch technique of antegrade humerus nailing.This is a retrospective study conducted at the Department of Orthopaedics in D. Y. Patil University, School of Medicine, Navi Mumbai, India. The study included 25 patients who were operated on from January 2019 to April 2021 and follow-ups done till May 2022. Inclusion criteria were adult patients with open humerus diaphyseal fractures (Gustilo-Anderson Classification). All patients with closed fractures, skeletally immature patients, and patients with associated head injury were excluded from the study. All patients were operated on with a minimally invasive Three-stitch technique for antegrade humerus nailing. All patients were evaluated based on DASH score.Out of the 25 patients included in the study, all patients showed complete union. The mean age of the patients was 40.4 years (range 23–66 years). The average period for consolidation of fracture was 10.56 weeks (range 8–14 weeks). The DASH score ranged from 0 to 15.8 with an average score of 2.96. Five patients reported complications with three patients of post-operative infection and delayed wound healing and two patients with screw loosening. All complications were resolved with proper wound care and the complete union was noted. None of the patients had an iatrogenic neurovascular injury.Three-stitch antegrade nailing technique is a novel method to treat diaphyseal humerus fractures and provides excellent results. It has various advantages such as minimal invasiveness, minimal injury to the rotator cuff, fewer infection rates, minimal iatrogenic injuries, and good functional outcomes. Therefore, this treatment modality can be effectively used for open humerus diaphyseal fractures.

FUNCTIONAL OUTCOME OF DIAPHYSEAL FRACTURES OF HUMERUS IN ADULTS TREATED WITH CLOSED INTERLOCKING NAILS: A PROSPECTIVE STUDY

Background: Diaphyseal fractures of humerus are common, representing 3% of all fractures and 20% of all humerus fractures. Though compression plate osteosynthesis is the gold standard, interlocking intramedullary nailing is also a reliable option. In this present study we evaluated the functional outcome of diaphyseal fractures of humerus treated with interlocking nails. A total of 36 patients with diaphyseal fractures of humerus, selected Materials and Methods: between OCTOBER 2020 to MAY 2021 were managed by closed interlocking nail of humerus. This was a prospective study and all patients were followed up to a minimum of 6 months. The primary outcome measures were functional outcome assessed using DASH Score (The Disabilities of the Arm, Shoulder &amp; Hand Score) &amp; Constant-Murley scoring system respectively. Secondary outcomes were intra-operative conditions such as operative time and blood loss and post-operative complications. The mean time of radiological union was 15.7 weeks ranging from14-26 Results: weeks. All 36 fractures were united including one delayed union which united at 26 weeks. In our series, 4 patients had post operative shoulder stiffness including one prominent nail, 1 patient developed radial nerve neuropraxia which recovered in 8 weeks. All patients were evaluated on the basis of Constant Murley score for shoulder function and DASH score. In our study of 36 patients 69.4% got excellent results, 19.4% got good results, 8.3% got moderate/fair results and 2.8% got poor results. Interlocking nailing is a relatively quick, minimally invasive, biomechanica Conclusion: lly sound, cosmetically better method of internal stabilization of shaft humerus fractures with less union time, less infection and lesser threat to radial nerve and other complications. Besides it allows early mobilization. With correct anatomical knowledge, preoperative planning, good surgical techniques and postoperative rehabilitation interlocking humeral nailing is a viable option in the management of fracture shaft humerus promising excellent outcome.

Inadequate proximal screw fixation increases risk of failure following plate fixation of diaphyseal humerus fractures

BackgroundOperative treatment of humeral shaft fractures (AO/OTA 12) is being performed more frequently. Accordingly, it is important to understand the complications associated with plate fixation. This study analyzes risk factors associated with mechanical failure following plate fixation of humeral shaft fractures in order to further elucidate the mode and location of failure.MethodsA retrospective review of 351 humeral shaft fractures was completed at a single level I trauma center. Eleven of eighty-five humeral shaft fractures had aseptic mechanical failure requiring revision (12.9%), following initial plate fixation. Fracture characteristics (AO type, comminution, location) and fracture fixation (plate type, multiplanar, number of screws proximal and distal to the fracture) were compared between aseptic mechanical failure and those without failure. A forward stepwise logistic regression analysis was performed to determine any significant predictors of aseptic mechanical failure.ResultsThere was significant differences in fixation between the aseptic mechanical failure group and those without failure, specifically in the number of screws for proximal fixation (p = 0.008) and distal fixation (p = 0.040). In the aseptic mechanical failure group, patients tended to have less than < 8 cortices of proximal fixation (82%) and less than < 8 cortices of distal fixation (64%). Conversely, in patients without mechanical failure there was a tendency to have greater than > 8 cortices in both the proximal (62%) and distal fixation (70%). A forward stepwise logistic regression analysis found that less than < 8 cortices of proximal fixation was a significant predictor of aseptic failure, OR 7.96 (p = 0.011). We think this can be accounted for due to the variable bone quality, thinner cortices and multiple torsional forces in the proximal shaft that may warrant special consideration for fixation.ConclusionThe current dogma of humeral shaft fracture stabilization is to use a minimum of 3 screws proximal and distal to the fracture, however the current study demonstrates this is associated with higher rates of mechanical failure. In contrast, 4 bicortical screws or more of fixation on either side of the fracture had lower failure rates and may help to reduce the risk of mechanical failure.Level of Evidence Level III.

Rehabilitation Features for Patients with Diaphyseal Humerus Fractures During Conservative Treatment

Aim: Determination of the key criteria for selecting the optimal physical rehabilitation scheme depending on the chosen method of conservative treatment. Materials and Methods: The study involved 53 patients with diaphyseal humerus fractures. In all cases, conservative functional treatment methods have been applied. Results: Based on the applied methods of conservative treatment, four clinical groups for medical rehabilitation have been identified: A, B, C, D, each containing 2 subgroups, depending on the relationship between the bone fragments and the sites of muscle attachment in the diaphyseal segment of the humerus. Subgroup “1” involved patients with diaphyseal humerus fractures, where the fragments serve as the sites of attachment for muscles. Subgroups “2” encompassed cases with fractures in the specified area, where the fragments do not serve as the sites of muscle insertion. The assessment of the functional activity of the elbow and shoulder joints was performed using the MEPS and CMS scales, respectively. Conclusions: The anatomical and topographical features of the muscle component are crucial for selecting the optimal tactics for conducting rehabilitation measures.

Functional outcome of diaphyseal fractures of humerus in adults treated with closed interlocking nails: A prospective study

Background: Diaphyseal fractures of humerus are common, representing 3% of all fractures and 20% of all humerus fractures. Though compression plate osteosynthesis is the gold standard, interlocking intramedullary nailing is also a reliable option. In this present study we evaluated the functional outcome of diaphyseal fractures of humerus treated with interlocking nails.Materials and Methods: A total of 36 patients with diaphyseal fractures of humerus, selected between October 2020 to May 2021 were managed by closed interlocking nail of humerus. This was a prospective study and all patients were followed up to a minimum of 6 months. The primary outcome measures were functional outcome assessed using DASH Score (The Disabilities of the Arm, Shoulder & Hand Score) & Constant-Murley scoring system respectively. Secondary outcomes were intra-operative conditions such as operative time and blood loss and post-operative complications.Results: The mean time of radiological union was 15.7 weeks ranging from14-26 weeks. All 36 fractures were united including one delayed union which united at 26 weeks. In our series, 4 patients had post-operative shoulder stiffness including one prominent nail, 1 patient developed radial nerve neuropraxia which recovered in 8 weeks. All patients were evaluated on the basis of Constant Murley score for shoulder function and DASH score. In our study of 36 patients 69.4% got excellent results, 19.4% got good results, 8.3% got moderate/fair results and 2.8% got poor results.Conclusion: Interlocking nailing is a relatively quick, minimally invasive, and biomechanically sound, cosmetically better method of internal stabilization of shaft humerus fractures with less union time, less infection and lesser threat to radial nerve and other complications. Besides it allows early mobilization. With correct anatomical knowledge, preoperative planning, good surgical techniques and postoperative rehabilitation interlocking humeral nailing is a viable option in the management of fracture shaft humerus promising excellent outcome.

Challenges in Management of Proximal Humerus Diaphyseal Fracture in a Patient with Brachial Plexus Birth Injury: A Case Report.

Two-and-a-half-month-old boy, a known case of brachial plexus birth injury, sustained proximal humeral diaphyseal fracture. Fracture healed in varus malunion and failed to remodel subsequently. Challenges were faced in the course of the management because of progression of the deformity. Finally, the fracture united after rigid internal fixation performed at 2.5 years. Neuromuscular imbalance can lead to angular deformity at fracture site and cause unpredictable remodeling, as in our case. Conservative management may fail to achieve union with satisfactory alignment. Rigid internal fixation should be considered in such cases to achieve union.

Evaluation and Management of Pediatric Humeral Shaft Fractures.

Diaphyseal humerus fractures in the pediatric population have dynamic treatment strategies that depend on injury pattern, mechanism, patient skeletal maturity, and size. Treatment strategies include closed reduction with various immobilization techniques, flexible nails, uniplanar or multiplanar external fixation, or plate osteosynthesis. Accepted parameters for sagittal and coronal alignment vary based on age and potential for remodeling, and the multiplanar motion of the shoulder joint can accommodate for greater variations in alignment than many other long bone fractures. Complications such as radial nerve palsy are possible with both open and closed injuries, and mal/nonunions, although rare, can occur. Overall, treatment should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries.