Humerus Shaft Fractures Research Articles

A Rare Aberrant Division of Radial Nerve Encountered During Fixation of Distal 1/3rd Shaft Humerus Fracture

A Rare Aberrant Division of Radial Nerve Encountered During Fixation of Distal 1/3rd Shaft Humerus Fracture

Single-Plate versus Dual-Plate Utilization for Treatment of Humeral Shaft Fractures: A Retrospective Clinical Series

Objectives Dual plating is the current standard of care for displaced distal humerus fractures and even some metadiaphyseal humeral fractures. Single plate fixation is the current standard of care for humeral shaft fractures when performing open reduction and internal fixation (ORIF). A role may exist for dual plating of humeral shaft fractures. This study aims to compare clinical outcomes of single versus dual-plating when performing ORIF procedures on humeral shaft fractures. Methods A retrospective study of 143 patients (81 females, 62 males; mean age 47.3) who sustained humeral shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (OTA/AO) type 12A, B, and C) and received either dual or single plating via ORIF between March 2010 and May 2022. Of the 143 patients, 79 (55%) received single plating, while 64 (45%) received dual plating. To account for possible confounders, we collected data on patient characteristics, mechanism of injury, and intra-surgical variables. Primary outcome measurements compared radiographical x-ray imaging (3-months, 6-months, and 12-months), complications, and visual analog scale (VAS) score. Results There was no statistically significant difference between VAS scores, union rates, post operative radial nerve injury, infections, or hardware failure for primary surgical outcomes. Patients were allowed to bear weight as tolerated more quickly in the dual-plating group. An association was observed between the usage of dual plates and osteoporosis. Conclusion In conclusion, we found dual-plate fixation for ORIF of humerus fractures to be not statistically significantly different compared to single plate fixation. Dual-plating has satisfactory radiograph and clinical outcomes compared to conventional single-plate fixation. While we are not advocating for the routine use of dual-plating, the results of our study suggest that the use of dual-plating produces similar outcomes when compared to single-plating for ORIF of a humerus shaft fracture.

Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures-a prospective comparative study.

To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This prospective interventional study was conducted among 30 patients by dividing into two equal groups over oneyear and sixmonths. All patients were followed up for a minimum of at least sixmonths. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. The majority of patients (26.7%) were between 18 to 30years, overall mean age was 44.4years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

Comparison the Results of Humerus Shaft Fractures Treated by Functional Bracing versus Dynamic Compression Plate

Introduction with Objective: To compare the results of humerus shaft fractures treated by functional bracing and dynamic compression plate. Materials and Methods: This experimental study was carried out at the Department of Orthopedic Surgery at Chittagong Medical College Hospital, Chattogram from August 2019 to July 2021. All adult patients of closed diaphyseal fracture of humerus attending the Orthopaedics department, Chittagong Medical College Hospital during study period were the study population. Purposive sampling was done according to availability of the patients. Cases were divided in two groups; group A (dynamic compression plate) and group B (functional bracing). All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science. The results were expressed as percentage and mean ± SD and p<0.05 was considered as the level of significant. Result: Average mean ± SD age was 40.22 ± 12.451 (range: 19-65) years. The mean age was 37.24 ± 10.686 in plating group and 43.20 ± 13.559 in bracing group. Out of 50 patients, 30 (60%) were male and 20 (40%) were female. Male was predominant in both groups (P=0.564). Regarding time taken for radiological union, average mean ± SD time was 15.32 ± 2.613 (range: 12-22) weeks. The mean time for radiological union was 14.91 ± 2.712 weeks in plating group and 15.76 ± 2.488 weeks in bracing group. Regarding ROM of shoulder & elbow, there was statistically nonsignificant difference found between the groups except shoulder flexion (P= 0.031s), abduction(P=0.025s) & extension(P=0.041s) more on plating group. QUICK-DASH score at 3 month shows highly significant difference between the study groups (p=0.001). At 6 and 12 month significant difference was found between the groups. Out of 44 patients at 12 months follow-up, 19 (43.2%) patient’s functional outcome was excellent and 10 (22.7%) patient’s functional outcome was good. Statistically significant difference was found between the groups (p=0.022). Conclusion: This study observed that functional outcome was relatively better in patients treated by dynamic compression plate in adult diaphyseal fracture of humerus. Medicine Today 2024, Vol.36 (2): 82-86

Enhanced nerve function recovery in radial nerve palsy patients with humerus shaft fracture: a randomized study of low-frequency pulse electrical stimulation combined with exercise therapy.

To evaluate the effect of low-frequency pulse electrical stimulation plus exercise therapy on nerve function recovery in patients with radial nerve palsy after humerus shaft fracture. A total of 110 patients with humerus shaft fracture and radial nerve injury admitted to our hospital from January 2017 to December 2021 were recruited. They were randomized to receive either conventional exercise therapy (control group) or conventional exercise therapy plus low-frequency pulse electrical stimulation (study group) according to the random number table method, with 55 cases in each. Clinical efficacy, muscle strength recovery, nerve conduction velocity (MCV), amplitude, wrist joint, and elbow joint activities of patients were analyzed and compared. Patients with low frequency stimulation (LFS) showed significantly higher treatment effectiveness (89.09%) than those with exercise therapy only (69.09%). The incorporation of LFS with exercise therapy provided more enhancement in the muscle strength of wrist extensor and total finger extensor in patients when compared with a mere exercise intervention, suggesting better muscle function recovery of patients produced by LFS. Moreover, a significant increase in MCV and its amplitude was observed in all included patients, among which those receiving LFS showed a greater escalation of MCV and its amplitude. Following a treatment duration of 6 months, more patients in the LFS cohort were reported to achieve a wrist extension and elbow extension with an angle over 45° than the controls. There was no notable variance in adverse responses noted between the two patient groups. In patients afflicted with humerus shaft fracture and radial nerve injury, the amalgamation of exercise therapy with low-frequency pulse electrical stimulation can significantly improve clinical efficacy, promote nerve function, and muscle strength recovery, and features a high safety profile. The combination of exercise therapy and low-frequency pulsed electrical stimulation can notably improve the promotion of neurologic function and muscle strength recovery in patients with humerus shaft fractures and radial nerve injuries with a high degree of safety.Clinical trial registration:https://www.researchregistry.com, identifier researchregistry9461.

A rare presentation of mid shaft humerus fracture with axillary artery & brachial artery traumatic thrombus with brachial plexus palsy

A rare presentation of mid shaft humerus fracture with axillary artery & brachial artery traumatic thrombus with brachial plexus palsy

Comparative Study of Union Rate in Closed Humerus Shaft Fracture After Operative Fixation with Anteromedial Versus Anterolateral Surface Plating Using the Anterolateral Approach: A Randomized Controlled Study

Purpose: Plate osteosynthesis is considered the gold standard for treating humeral shaft fractures, and orthopedic surgeons widely use the anterolateral approach with anterolateral surface placement. However, surgeons may have difficulties with the non-smooth surface and proximity to the radial nerve during their use. To address this challenge, we propose introducing the anterolateral approach with anteromedial surface placement. This study aimed to compare the outcomes between anteromedial and anterolateral surface plating using the anterolateral approach. Methods: This study included 74 patients who sustained a mid-shaft humerus fracture (AO 12) and underwent open reduction internal fixation between December 2020 and December 2022. Twelve patients were excluded based on the exclusion criteria. Among the remaining patients, 30 were randomized and allocated to surgery with anteromedial surface plating, while 32 patients were treated with anterolateral surface plating through an anterolateral approach. Postoperative clinical and radiographic results were recorded and analyzed. Results: The union rate, blood loss, operative time, and complications were not significantly different between the two groups. All the patients healed radiographically except for two in the anterolateral surface plating group, who required reoperation. Although anteroposterior alignment was significantly better in the anteromedial surface plating group, it was not clinically significant. Conclusions: Anteromedial plating demonstrated a commendable union rate, offered assured alignment, and presented itself as a secure option for addressing fractures of the humerus shaft.

Humerus shaft fracture caused by arm wrestling injury: examination of mechanism through radiological analysis

Humerus shaft fracture caused by arm wrestling injury: examination of mechanism through radiological analysis

Functional outcome of the three-stitch technique of humerus nailing for comminuted shaft humerus fractures

Abstract Background: Intramedullary nailing for comminuted shaft humerus fractures has emerged as an innovative and advantageous surgical approach, particularly in cases with significant soft tissue injuries complicating open reduction and internal fixation. This study underscores the benefits of minimally invasive intramedullary humerus nailing to mitigate perioperative and postoperative complications. Materials and Methods: This prospective study was conducted at Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India, from March 2022 to March 2024. Informed consent was obtained from all patients, detailing the study’s methodologies and potential complications. Employing a three-stitch technique, we treated 24 adult patients with posttraumatic comminuted humerus shaft fractures through antegrade humerus nailing, encompassing injuries classified up to type 12C according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification. Results: Among the 24 patients, 22 exhibited excellent functional outcomes and good adherence to the rehabilitation regimen. Two patients encountered delayed wound healing; one underwent vacuum-assisted closure therapy, ultimately achieving satisfactory healing after a series of dry dressings over 2–3 weeks. There were no instances of nonunion. Over 6 months, 22 out of 24 patients experienced significant restoration of function, evidenced by an improvement in Mayo Elbow Performance Index scores from 18 to 23 within the excellent outcome group. University of California at Los Angeles scores also exhibited enhancement, with ratings ranging from exceptional to good, increasing from 20 to 23. Only two patients experienced delayed wound healing, and none suffered from nonunions. Conclusion: Our findings suggest that the three-stitch technique presents a viable alternative to external fixators and other plate osteosynthesis methods in the surgical management of comminuted injuries. This approach yields favorable outcomes with reduced complications and improved cosmetic results.

A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India.This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively.There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study.An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Primary Radial Nerve Lesions in Humerus Shaft Fractures-Revision or Wait and See.

Background: This study investigates the surgical state-of-the-art procedure for humeral shaft fractures with primary radial nerve palsy based on its own case series in relation to the current and established literature. Methods: Retrospective review of treated cases between January 2018 and December 2022 describing radial nerve palsy after humerus shaft fractures, radiological fracture classification, intraoperative findings, surgical procedure, patient follow-up and functional outcome. Results: A total of 804 patients (463 women and 341 men) with humerus shaft fractures were identified. A total of 33 patients showed symptomatic lesions of the radial nerve (4.1%). The primary lesion was identified in 17 patients (2.1%). A broad and inhomogeneous distribution of fractures according to the AO classification was found. According to the operative reports, the distraction of the radial nerve was found eleven times, bony interposed three times and soft tissue constricted/compressed three times. In every case the radial nerve was surgically explored, there was no case of complete traumatic nerve transection. Four intramedullary nails and thirteen locking plates were used for osteosynthesis. Complete recovery of nerve function was seen in 12 cases within 1 to 36 months. Three patients still showed mild hypesthesia in the thumb area after 18 months. Two patients were lost during follow-up. Conclusions: With this study, we support the strategy of early nerve exploration and plate osteosynthesis in humeral fractures with primary radial nerve palsy when there is a clear indication for surgical fracture stabilisation. In addition, early exploration appears sensible in the case of palsies in open fractures and secondary palsy following surgery without nerve exposure as well as in the case of diagnostically recognisable nerve damage. Late nerve exploration is recommended if there are no definite signs of recovery after 6 months. An initial wait-and-see strategy with clinical observation seems reasonable for primary radial nerve palsies without indication for surgical fracture stabilisation.

Available, Effective, Cheap, and Easy to Prepare with Safe Reputation Among Community, Fenugreek: A Short Commentary

This is a short commentary made regarding the recent study authored by Aldhilan et al. Titled “The Healing CallusPromoting Effect of Fenugreek in a Humerus Shaft Fracture: A Case Report” published in Cureus.

Is Elastic Stable Intramedullary Nailing a Viable Treatment Option for Diaphyseal Fractures of the Humerus in Adults? A 29-case Series Prospective Study.

Humerus shaft fractures are common in orthopaedic practice. The emphasis in treatment has shifted from prolonged immobilisation to early mobilisation and internal fixation when needed for a quicker return to normal function. Internal fixation methods include plate osteosynthesis and intramedullary nailing. This study specifically evaluated the effectiveness of flexible intramedullary nails in treating diaphyseal humeral fractures. Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) with diaphyseal humeral fractures. Treatment involved closed reduction and percutaneous fixation using two flexible nails. Patients, aged 17 to 65 with a mean age of 32, were included if they did not have pathological fractures, were above 16 years old, and were medically suitable. Causes included pedestrian vehicle accidents (17 cases) and falls or sports-related activities (12 cases). Surgical intervention occurred 1 to 8 days after the injury. Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) for diaphyseal humeral fractures using closed reduction and percutaneous fixation with two flexible nails. Patients, aged 17 to 65, were monitored for an average of 18 months. Radiographic assessments showed complete union in nineteen fractures within 13 to 21 weeks. One patient experienced non-union but was successfully treated with bone grafting and plating. There were no significant intraoperative complications. Notably, four patients with preoperative radial nerve injuries recovered within 6 to 8 weeks. Evaluation using the Stewart and Hundley Scoring technique showed excellent outcomes for 60% of patients, good outcomes for 30%, fair outcomes for 5%, and poor outcomes for 5%. 1.The Elastic Stable Intramedullary Nailing (ESIN) technique shows promise in the treatment of humeral shaft fractures. 2. However, the success of treatment may depend on various factors, including patient age, fracture characteristics, and the presence of complications such as open fractures and radial nerve palsy. 3. Careful consideration of these factors is necessary when selecting a treatment approach for humeral shaft fractures.

Epidemiology of humerus shaft fractures in children-observational study of 50 patients

Background: Objective was to study the epidemiology of humerus shaft fracture in children. Methods: This was an observational study of 50 cases of humeral diaphyseal fractures in children aged between 5 to 15 years reporting to tertiary care center over a period of 18 months. Each patient was categorized with respect to age, sex, mode of trauma, side injured, type of fracture, associated injuries, modality of treatment given. Results: Most patients belonged to upper lower class (66 %), and 80% patient belonged to rural population. Boys (60%) were more prone to have humerus shaft fracture than girls. Mean age of the patient were 10.12 years (±2.6 SD). Most common mode of trauma was accidental fall on arm (68%). Traumatic fracture was noted in 94% of cases while 6 % cases were having pathological fracture. Most patients were having middle third shaft fracture (40%), followed by distal third (30%) and lastly proximal third (22%), and left side involvement (58%) was more. Out of the 50 patients, poly trauma was observed in 4 cases, multiple bone fracture was noted in 2 cases, while 2 patients were having fibrous dysplasia and 1 with bony cyst as an associated cause of pathological fracture and 1 patient had radial nerve injury pre-operatively. Conclusions: The findings of this study provide valuable insights into the epidemiology of humerus shaft fractures in children in respect to age, sex, socio-economic status, mode of trauma. These data can help understand the risk factors and help in preventing the incidence. Most of these fracture can be managed successfully with retrograde titanium elastic nailing system (TENS) nailing with minimal complications.

A Comparative Analysis of Locking Plate versus Intramedullary Nail for Humerus Shaft Fractures

Introduction: Humerus shaft fractures pose a significant challenge in Orthopaedic practice, with various treatment approaches available, including surgical methods like conservative management, Plating and Nailing. The choice between these methods remains debatable, necessitating further comparative studies. Methods: This study compared Open Reduction Internal Fixation (ORIF) with Locking Compression Plates and Closed Reduction Internal Fixation (CRIF) with Intramedullary Interlocking nails for Humerus shaft fractures. Patients were categorized into two groups based on the intervention received. Perioperative parameters, radiological outcomes, and complications were assessed. Results: Baseline demographics were comparable between the two groups. The Plating Group had longer surgery duration and higher blood loss compared to the Nailing Group. Both groups had similar rates of union and non-union, with no significant difference in shoulder function and pain outcomes at one year post-operation. Discussion: Functional outcomes post-union remain acceptable despite notable deformities, suggesting the viability of conservative treatments. While ORIF with plating has been conventional, concerns over blood loss and nerve injury have led to exploration of CRIF with intramedullary nails. This study, consistent with previous findings, found no significant disparity in outcomes between the two methods, emphasizing the need for personalized treatment decisions. In conclusion, this study adds to the understanding of Humerus shaft fracture management, highlighting the need for individualized treatment decisions and further research in this field.

A Retrospective Analysis of Dynamic Compression Plating Versus Intramedullary Nailing for the Management of Shaft of Humerus Fractures in an Urban Trauma Care Center.

Introduction There is constant debate regarding the best surgical technique for the fixation of shaft humerus fractures. Intramedullary nailing and dynamic compression plating are the most popular surgical options. Materials and methods In our study, we retrospectively analyze the results of 27 patients with shaft humerus fractures managed with intramedullary nailing (10) and dynamic compression plating (17) at our institute from September 2021 to October 2022. Preoperative clinical assessment sheets, postoperative follow-up sheets, operative notes, anesthesia sheets, and preoperative and follow-up radiographs were analyzed. Reamed antegrade nailing was done in all cases, while dynamic compression plating was done through a posterior approach. Results The operative time of the nailing group was 82.1 ± 7.61 mins, which was significantly lesser (P value <0.05) than that of the plating group, which was 119.59 ± 10.16 mins. The intraoperative blood loss of the patients who were managed with nailing was 71 ± 7.38 mL, which was significantly lesser (P value <0.05) than that of the plating group, which was 130.59 ± 11.44 mL. The patients in both groups had a statistically nonsignificant difference in terms of functional results, which were assessed using Rodriguez-Merchan criteria. Complications were similar in both groups with infection (17.65%), and postoperative radial nerve palsy (11.76%) was more common among the patients undergoing plating, and shoulder impingement(20%) was common among those undergoing nailing. Conclusion This study concluded that both surgical options are similar in the case of functional results. The selection of the surgical method should be as per the surgeon's surgical familiarity and personalized to individual patients.

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.

Variation in the Branching Pattern of the Radial Nerve Observed during Fixation of the Humerus Shaft: A Case Report

The posterior cord of the brachial plexus typically maintains a consistent branching pattern, and deviations from this norm are exceedingly rare. Even more infrequently encountered are variations in the branching pattern of the radial nerve. The current case report of a 45-year-old male patient presents a unique clinical scenario involving a middle third and distal third humerus shaft fracture, manifesting as the chief complaint of pain during movement, coupled with localised swelling. A posterior approach was employed for surgical intervention due to the expansile nature of the fracture within the middle and distal thirds. During the surgical exploration, an anomalous branching pattern of the radial nerve was observed when transitioning from the posterior to the anterior compartment. This atypical radial nerve branching consisted of a branch extending into the anterior compartment and an accompanying posteroinferior branch, which notably supplied the medial and long heads of the triceps muscle. The present case underscores the imperative role of the orthopaedic surgeon in considering the radial nerve's intricate anatomy while exposing and stabilising segmental humerus fractures. It is of paramount importance to exercise vigilance, as the conventional practice of splitting the triceps muscle should be abstained from until an unusual branching or splitting of the radial nerve is definitively ruled out. The present case report elucidates the significance of meticulous anatomical awareness and surgical technique when addressing such complex humeral fractures, offering insights into the management of these uncommon clinical presentations.

Assessment of Functional Outcome of Humeral Diaphyseal Fractures Treated with Dynamic Compression Plate at National Medical College and Teaching Hospital, Birgunj, Nepal

Introduction: Fractures of the humeral shaft account for roughly 3-5% of all fractures and result from direct and indirect trauma. Common mechanism for this fractures include fall on the motor vehicle accidents, fall on out stretched hand and direct loads to the arm. The shaft of humerus fracture is managed largely conservatively, but with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, more time consuming with conservative management, many surgeon are increasingly likely to consider surgical management. The aim of our study is to assess the functional outcome of dynamic compression plate in shaft of humerus fracture.Materials and Methods: This is a prospective observational study conductedm in department of orthopedic surgery, NMCTH, Birgunj among 45 patients from 17 years and above presenting with shaft of humerus fracture. The fracture was classified according to AO classification. The patients were treated with open reduction and internal fixation with dynamic compression plate and followed up at 2 weeks, 6 weeks, 12 weeks and 24 weeks till the radiological union was achieved. American shoulder and elbow surgeon’s scoring system was used to assess the final outcome of the study.Results: 45 patients meeting inclusion criteria were included in the study, 3 patients lost follow up hence removed from study. Out of 42 patients, mean age of the patient was 31.95 years. Most of them 27(64.3%) were male. Predominant fracture was on left side 73.8% (31 patients). The study finding showed that 31(73.8%) sustained injury due to road traffic accidents. Majority of the fractures 32(76.20%) were in middle 1/3rd. Most of the patient had A3 type of fracture according to AO classification. The mean post-operative immobilization was 15 years. Forty one (97.61%) fracture united with one (2.39%) fracture going into non-union with mean time of 16.04 weeks. Thirty-seven (88.10%) patients has excellent range of motion of elbow and shoulder while 3(7.10%) had good and 2(4.8%) patient had poor functional outcome. The average ASES score obtained at 24 weeks was 47.07.Conclusion: From our study, it is concluded that open reduction and internal fixation with DCP in shaft of humerus fracture provides excellent functional outcome.

Intramedullary Nails vs Open Reduction in Internal Fixation for Humeral Shaft Fractures: A Meta-Analysis of Randomized Control Trials.

The purpose of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare outcomes following intramedullary nailing (IMN) vs. open reduction and internal fixation (ORIF) of humeral shaft fractures. A literature search of three databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing IMN and ORIF for humeral shaft fractures were included. Clinical outcomes were compared using Revman. P value < 0.05 was considered to be statistically significant. Ten RCTs with 512 patients were included. Overall, 8.4% of patients treated with IMN and 6.4% of patients with ORIF had a non-union (p = 0.57, I2 = 0%), with a significantly faster time to union with IMN (10 weeks vs 11.9 weeks , p < 0.05). There was no significant difference in re-operations (11.6% IMN vs 7.6% ORIF, p = 0.26) or radial nerve palsies (2.8% IMN vs 4.2% ORIF, p = 0.58). A lower rate of infection was noted with IMN (1.2% vs 5.3%, p < 0.5). Additionally, there was a lower operative time with IMN (61 minutes vs 88 minutes, p < 0.05). The level I evidence in the literature does not show a significant difference in union rates, re-operations or radial nerve palsies between IMN and ORIF for humerus shaft fractures. Overall, treatment with IMN results in lower infection rates, less operative time, and modestly quicker time to union. Optimal treatment strategy for humeral shaft fractures may be best informed by fracture pattern and surgeon preference.