Humerus Shaft Fractures Research Articles

Nonunion of the humeral shaft: About 42 cases in the orthopaedic-traumatology department of the CHU ignace deen in Conakry

Introduction: Nonunion or pseudarthrosis is the leading late complication of humerus shaft fractures. This study's objective was to report our department's experience managing pseudarthrosis of the humeral shaft.Patients and Methods: This was a cross-sectional study with a retrospective collection of descriptive type lasting ten (10) years from January 2010 to December 2020. It focused on the files of patients hospitalized and treated for nonunion of the humeral shaft.Results: We recorded 42 cases of nonunion of the humeral shaft. The average age of the patients was 20 years old, with a male predominance of 66.67% and a sex ratio of two. The closed fracture was the most frequent initial lesion in 88.10%, and the traditional treatment was carried out in 73.91% of patients. Aseptic nonunion was the most found in 71.43%, of which 38.10% were hypertrophic. Osteosynthesis by screwed plate was the most performed in 71.43%, allowing the union to be obtained in 95.24% of patients within an average period of five months.Conclusion: Nonunion of the humeral shaft is a frequent late complication of humeral fractures whose surgical treatment gives satisfactory results.

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.

Functional and clinical outcome of minimally invasive anterior bridge platting in humerus shaft fractures

Introduction: To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures. This study is done to evaluated the clinical, radiological, and functional outcome of mid shaft humerus fractures in 30 patients, all of which were managed with MIPPO. over an average follow up period of 12 months.Materials and Method: 30 patients fulfilling inclusion criteria were treated with ABP by using a 4.5-mm dynamic/locking compression plate and followed for a period of 12 month. Functional outcome was assessed using the UCLA & Mayo elbow scores. Range of motion (ROM), subjective strength, and radiographic union were assessed.Results: Out of the 30 patients in the study, 24 were males and 6 were females. The mean age was 36 years (range 26 to 65 years). 22 out of 30 patients (73%) had the dominant side fractured. Mean surgical time in minutes was 60 min (range: 35-80 min).The mean fracture union (radiological) time was 10.6 weeks (range: 08–16 weeks). However Shoulder function was excellent to good in 28 cases (93.3%) and fair in 2 case (6.7%) on the UCLA score and excellent in 28 cases(93.3%) and fair in 2 cases (6.7%) on mayo elbow score.The majority of patients (28 patients, 93.3%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (6.7%) of non-union.Conclusion: ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It works on the principal of relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature preserves the soft tissue envelope and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.

Humerus Shaft Fractures Managed by Locking Compression Plate

Background: The incidence of nonunion of humerus has been as high as 15% of all humeral fractures. Majority of humeral shaft fractures were treated by conservative treatment using splints, hanging arm cast, braces compromising anatomical reduction in view of wide range of movement of shoulder and elbow joint. Methods: The prospective study was conducted at Dept. of Ortho-Surgery, Sheikh Sayera Khatun Medical College & Hospital, Gopalgonj, Bangladesh from January 2021 to June 2022. Total 20 patients with fracture shaft humerus, who were treated with locking compression plate from the period were study. All patients are admitted and subjected to clinical & radiological examination, necessary lab investigations are carried out for proposed surgery. Regular follow up will be carried out by clinical examination and with X-rays at interval of 6 weeks, 3 months than 6 months and study will be conducted on a minimum of 20 patients. Results: Total 20 patients with fracture shaft humerus, who were treated with locking compression plate from the period of study. The age group of the patients in our study ranged from 15 years to 65 years. Most of the patients belong to 21- 40 years. 65% with male predominance (70%), with type A3 as the commonest fracture (50%) involving the mid shaft (70%) of humerus, underwent open reduction and internal fixation using locking compression plate. Conclusion: The age of the patient ranged from 15 years to 65. Majority of the patients were males. (M: F = 14: 6). In our series, left humerus was involved in 50% cases, while right was involved in the other 50% of cases.

Fixation of humerus shaft fractures in polytrauma patients does not improve short-term outcomes

BackgroundSurgical fixation of humeral shaft fractures is widely considered a relative indication for polytraumatized patients to improve mobility and expedite care. This study aimed to determine whether operative treatment of humeral shaft fractures improves short term outcomes in polytrauma (PT] patients. MethodsUsing the National Trauma Data Bank, PT patients with humeral shaft fractures were identified from 2010-2015. Three PT groups were analyzed: Group 1 – PT with nonoperative humeral shaft fracture, Group 2 – PT with humeral fixation on Day 1, and Group 3 – PT with humeral fixation on Day 2+. Cox proportional hazards regression models were used to compare discharge timing and days on ventilator and in ICU between the three groups. ResultsThere were 395 patients in Group 1, 1,346 in Group 2, and 1,318 in Group 3. There were no differences between the three groups when comparing Glasgow Coma Scale (p=0.3]; however, Injury Severity Score and Abbreviated Injury Scale were statistically different (p<0.001]. No differences were found in ICU or ventilator days between the three groups (p=0.2, p=0.5]. For Length of Stay, no difference was observed in Group 1 vs. Group 2 and Group 2 vs. Group 3. However, non-surgical patients were discharged 20% faster than those with Day 1 surgery (p=0.005]. Open fractures were treated one day earlier than closed fractures but discharged one day later (p<0.001]. ConclusionsThis NTDB study demonstrates no differences in length of stay, days in the ICU or on the ventilator in patients with humeral shaft fractures treated non-operatively versus operative fixation. Overall, 44%-58% in all 3 groups had an ISS ≥ 14. Based on these results, we assert that fixation of the humeral shaft provides no short-term benefits in the multiply injured patient.

Exploration of radial nerve in patients with humerus shaft fracture with radial nerve palsy, is it necessary?

&lt;p&gt;Fractures in the distal third of the humerus shaft usually are associated with complete or incomplete radial nerve lesions which may be caused due to traction, entrapment or compression between bony fragments. We managed these patients by bridge plating using minimally invasive percutaneous plate osteosynthesis. A total of 5 patients were operated on and all showed full functional recovery of radial nerve. Fracture united in all cases and no patient developed any complication.&lt;/p&gt;

Comparison of functional status, outcome of patient and complications in dynamic compression plating &amp; interlocking nail in fixation of fracture shaft humerus

Background: Management of fractures is ever evolving and humeral shaft fractures are no exception to this. Historically, management of fractures was centred around conservative methods. Treatment methods for these injuries continue to evolve as advances are made in both non-operative and operative management. Objective: To compare functional status and outcome of patient and complications in Dynamic Compression Plating &amp; Interlocking Nail in fixation of fracture shaft humerus. Methodology: The present study was conducted in the Department of Orthopaedics, Govt. multispecialty Hospital, Sec. 16, Chandigarh during the years 2010-12. In this study 15 patients for each group i.e. Dynamic Compression Plating and Interlocking Nail were studied. Results: Functional outcome was assessed according to ASES Score. 46.7% cases in group I and 73.3% cases in group II had score of grade I. The incidence of complications like non-union, shoulder stiffness, implant failure was higher in group I. Conclusion: Complications are less with plating as compared with nailing. Incidence of shoulder stiffness, impingement is associated with nailing. Nailing has higher incidence of non union.

Data on inter-locking nail in humeral shaft fractures among Indian patients.

Humeral shaft fractures are commonly seen orthopaedics injuries. Open reduction with internal fixation (ORIF) with plating is a gold standard procedure despite various issues such as infection, radial nerve palsy and no-nunion. Close reduction with interlocking nails (ILN) is not a very popular procedure. Therefore, it is of interest to collect data on the significance of interlocking nail in different pattern of humerus shaft fracture. 30 patients with closed humeral shaft fracture participated in this study. The fractures were classified according to their descriptive location as proximal, middle and distal. All surgeries were performed by a single surgeon familiar with the ILN procedure. All patients had appropriate clinical, radiological and pre and postoperative assessment. Data on patients were collected at 2, 6weeks, 12weeks, 18 weeks and 6 months. 19 cases with middle third and distal third fractures were united within 10-14 weeks. 6 cases of proximal shaft fracture were united in 14-18 weeks. According to Rodrı ´guez-Merchant criteria - Middle shaft fracture has shown good results (n=9, 75%) followed by distal third shaft fracture (n=6, 60%) and proximal third fracture (n=1, 12.5%). Though there is decrease in mean ASES score in all three groups of fractures but the Mid shaft fracture has shown significant decline in ASES score suggesting improvement in pain and ROM after 6 months. Thus, ILN of humerus is a simple and a safe procedure for treating fractures of middle and distal third shaft humerus. However, this study does not support ILN for the management of proximal third humerus fracture.

Dynamic Compression Plating Versus Interlocking Nail Procedure for Fracture Shaft of Humerus; A Comparative Study

Objective: To evaluate the efficacy of dynamic compression plating against interlocking nail technique for the treatment of humeral shaft fractures. Study Design: Randomized controlled trial Place &amp; Duration: Department of Orthopedic, Mardan Medical Complex, Mardan for the period of two years from April 2020 to October 2021. Methods: Fifty six patients (18-65 years old) of both sexes were included in the study because they had a humeral shaft fracture. The patients were randomly split into two groups. Both the dynamic compression plating group (n = 28) and the interlocking nail group (n = 28) received treatment. Radiographic examination both before and after surgery were performed. At the 12-day post-operative, complications following the operation were observed. The NEERs criteria were used to analyse the results of the functional assessments. Follow-up was taken at 6 months postoperatively. Results: Mean age of patients was 41.46±10.74 years. 42 (75%) patients were males while 25% were females. Road traffic accident was the most common cause found in 37 (66.07%) patients. Mean union time in DCP and INL group was 11.62±3.05 and 13.54±4.73 weeks. Shoulder stiffness was the commonest complication in both groups. At final follow up, in DCP group 24 (85.71%), 2 (7.14%) and 2 (7.14%) patients had excellent, good and fair outcomes, while in group B (INL) 19 (67.86%), 5 (17.86%) and 4 (14.29%) patients had excellent, good and fair outcomes. No significant difference was found in both groups regarding functional outcomes. Patients satisfaction was high in DCP group as compared to INL. Conclusion: Dynamic compression plating shows better outcomes in term of union time, complications and functional outcomes as compared to interlocking nail Technique. Keywords: Dynamic Compression Plating, Interlocking Nailing, Fracture Shaft of Humerus

Frequency of Radial Nerve Palsy in Patients with Closed Traumatic Humeral Shaft Fracture in High Energy Trauma Cases

Background: Different pattern of the fractures of the humerus shaft usually result in radial nerve injury. The frequent injury of radial nerve is because of its close proximity to the humeral shaft in the radial groove. Objective: Determining the incidence of Radial Nerve Injuries in Patients with Closed type of Humeral Shaft Fractures in high-energy trauma cases. Material and Methods:Department of Orthopedics conducted this study at Ghurki Trust &amp; Teaching Hospital, Lahore from January 2021 to December 2021, including all patients regardless of gender, aged between 20-60 years with closed fractures at the level of shaft of humerus. All the patients were thoroughly investigated with detailed history, clinical and radiological examination. The patients were originally managed according to standard ward procedures, fracture stabilization with U-slab and analgesic requirements. All of the patients were clinically examined to rule out radial nerve damage. The data accumulated after completion was analyzed using the relative software SPSS version 26.0. Results: This study included 80 patients with radiologically confirmed humeral shaft fractures. There were 55 (68.5%) men and 25 (31.25%) women having this type of fracture pattern. The participants ages were inbetween 20 to 60 years, with men and women having mean ages of 31.62 ±8.35 years and 38.43±5.06 years, respectively, and overall mean age of 38.93± 6.19 years. Spiral fractures accounted for 32 (40%) of the cases, while transverse fractures17 (21.25%), communited fractures16 (20%) and segmental fractures 15(18.75%). In 7 (or 8.75 percent) out of the 80 patients, radial nerve injury was observed. 4 (57.1%) cases of radial nerve damage were found in patients with spiral closed midshaft humerus fractures, 1 (14.3%) reported case in transverse closed humerus shaft fractures, 1 (14.3%) case in comminuted closed midshaft humerus fractures, and 1 (14.3%) case in segmental fractures. Conclusion: This study highlighted the frequency of radial nerve palsy among the patients with humeral shaft fractures at spiral goove . Radial nerve palsy was found in 8.75% of cases presented to our setup.Most of these cases reported in patients with spiral type of fracture of humerus midshaft. These findings are helpful to the surgeons during the pre operative counseling of patients, who suffered radial nerve damage due to a humerus shaft fracture at radial groove. Keywords:Radial Nerve Injury, Closed fracture of the humerus, Radial groove ,Humerus Shaft

INTRA-MEDULLARY NAILING FOR HUMERAL SHAFT FRACTURES:A CASE SERIES

Humeral shaft fractures have always been amenable to conservative treatment with good success. However, there are many fractures which need to be operated. Intra-medullary nailing, while being a very popular method of xation of long bone fractures of the lower extremity, has not gained similar traction in the humerus. We investigate a series of patients operated at our institution with intramedullary nailing, and outline the success of this procedure, and the problems encountered. This study was conducted at the Government Hospital for Bone &amp; Joint Surgery, Srinagar, and included a total of 31 patients with humeral shaft fractures from August 2017 to September 2021. All these fractures were xed using reamed intramedullary nailing. Of the 31 patients, 22 were male, and 9 were female, with a mean age of 35.28 years. Mean time to union was 12.6 weeks. We encountered many complications in our series of patients. Three (9.6%) patients had a delayed union, one (3.22%) had proximal nail impingement, one (3.22%) had entry site iatrogenic comminution, two patients (6.4%) had supercial surgical site infection, and 11 (35.5%) patients had persistent shoulder pain. We concluded that Intramedullary nailing of the humerus is a safe, and effective procedure for humerus shaft fractures. However, problems related to the entry site are possible, and are a common cause for morbidity even after fracture union.

A Rare Case of Comminuted Fracture Shaft Humerus with Intercondylar Extension with Monteggia Dislocation and Its Management

Background: Monteggia fracture-dislocation is a rare entity in adults with an incidence of less than 1%. However, a combination of fracture shaft humerus with distal intraarticular extension along with monteggia fracture-dislocation in an ipsilateral upper limb is very hard to find and manage, owing to its rare presentation. Materials and Methods: In this report, we detailed the surgical management of comminuted fracture(splinter) of shaft humerus with intercondylar extension AO C2 with typeII monteggia fracture-dislocation with the usage of proper implants in a 25year old male with a 3 year follow-up. Result: It shows that the fracture united well at the appropriate period and the elbow range of movements was satisfactorily ranging from 20° to 130° with no limitation in supination and pronation. Conclusion: Such complex elbow injuries are difficult to find in the literature. This study addresses the proper surgical management in terms of approach and usage of appropriate implants to improve the long-term functional outcome when dealing with such injuries.

OUTCOME OF ANTEROMEDIAL PLATING VERSES ANTEROLATERAL TECHNIQUE FOR FRACTURE OF MIDDLE 1/3RD OF THE HUMERUS

Background: Humerus shaft fracture accounts for 3-5% of all fractures commonly encountered by orthopedic surgeons. The application of plate for fracture of middle 1/3rd of Humerus is a gold standard in the presence of lot of intramedullary and extramedullary devices for these fractures.&#x0D; Objectives: To compare the outcome of anterolateral plating with the anteromedial plating for fracture of middle 1/3rd of the Humerus.&#x0D; Subjects and Methods: &#x0D; Study Design: Randomized control trial&#x0D; Study Setting: Department of orthopedic surgery services hospital Lahore&#x0D; Study Duration: Jan 2018 to Jan 2019&#x0D; Data collection and Analysis:&#x0D; Total number 60 patients with fracture of middle 1/3rd of shaft of the humerus were admitted through emergency department of this hospital. Subjects were randomly assigned into two equal groups. In Group A all fractures were fixed with DCP on the anterolateral surface of Humerus with anterolateral approach while in group B all 30 patients with fracture of shaft of Humerus were plated on the medial flat surface of Humerus by anterolateral technique. The radial nerve injury was also assessed in both of these groups post operatively. All these patients were followed for 6 months with weekly interval up to 03 weeks, then at 06 weeks, 03 months and thereafter at 06 months. At each follow up each patient was evaluated clinically and radiologically for fracture union range of motion at elbow and shoulder joint and post operative complications. Data was entered and analyzed in SPSS ver: 21.0. Mean and standard deviation was calculated for quantitative variables and frequency and percentages for qualitative variables. Independent t–test was applied for numerical outcome and chi-square test was used for proportions with p &lt; .05 as statistical significant.&#x0D; Results: Mean age 42.2 + 5.98 years. 66.6% of the fractures were as a result of RTA Mean duration of surgery in Group A (Anterolateral surface) was 60.25 + 7.56 and in Group B (Anteromedial surface) was 52.34 + 10.29. (p &lt; .001). Mean blood loss in group A was 110.17 + 12.36 and in Group B was 80.75 + 8.94 (p &lt; .000). No radial nerve injury in group B while 3 (10.0%) patients had iatrogenic radial nerve palsy in group A (p =.076).&#x0D; Conclusion: Anteromedial plating on the flat medial surface of Humerus is an excellent technique for fixation of fractures of middle 1/3rd of the Humerus as compared to anterolateral plating. It avoids the injury to the radial nerve.

Humeral fractures sustained during arm wrestling.

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

Anterior bridge plating by minimally invasive plate osteosynthesis in humerus shaft fractures

Introduction: Shaft humerus fractures constitute 1-3% and 20% of all fractures of the humerus. For shaft humerus fractures, fixation with absolute stability using Dynamic Compression Plate by open technique is today’s gold standard. MIPO was developed to attain a more stable fixation, which might improve the union rate and cut back complications related to open plating together with infection and induced radial nerve palsy. Materials & Methods: 25 cases of fracture of shaft humerus fractures were studied. During the period from August 2015 to July 2017. Case selection was done in the criteria of history, clinical examination and radiological (X-ray) examination. Result was noted according to UCLA score & MEP score and filled up. Results: 100% union seen in our cases. Union was achieved in 12-14 weeks in 13(52%) of patients, 14-16 weeks in 9 (36%) of the patients and more than 16 weeks in the remaining 3(12%) patients with average time to union being 14.24 weeks. It was observed that the majority of the cases had excellent 17(68%), Good 5(20%) UCLA and 3(12%) had fair UCLA. Only 2 cases had less than an excellent MEP score, while the rest had excellent scores. Conclusion: Anterior Bridge plating by Minimally Invasive Plate Osteosynthesis in shaft humerus fractures showed promising results. They provide relative stability to the fracture site and fracture hematoma is not disturbed. MIPO preserves the vascularity and hence decreases the risk of infection and wound breakdown.

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

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

Consequences of the COVID-19 pandemic on fracture distribution: Epidemiological data from a tertiary trauma center in Turkey

Redefinition of our social life for COVID-19, with social distance, prohibition of entering and exiting cities, closure of social areas and curfews effects every aspect of our lives, from psychological to physical. The aim of this study was to evaluate the injury mechanisms, fracture frequencies and priority treatment preferences in a tertiary trauma center from Turkey during the COVID-19 pandemic, both in adult and pediatric populations, and to compare them with pre-COVID-19 period. In this single-centered study, 960 patients (with 1039 fractures) who were admitted to a tertiary trauma center in Turkey, between April 2020 and December 2020 were examined. A control group of 964 patients (with 1070 fractures) who were admitted in the same date range of 2019 was formed. Patient demographics, injury mechanisms, fracture type and preferred treatment methods were recorded. There was a significant difference regarding injury mechanism between groups in both adult and pediatric populations (p=0.002 and p&lt;0.001, respectively). In adults, according to the residual values, there was significant difference between groups in terms of proximal humerus, elbow, forearm, hand, femoral shaft and knee fractures (p&lt;0.001). Among pediatric patients, a significant difference was found between groups in terms of proximal humerus, hand and knee fractures (p&lt;0.001). In the pediatric population, there has been a significant increase in the preference of conservative treatment in the pandemic group (p=0.002). With increased indoors time, restriction of outdoors physical activities and lesser time in traffic, fracture distribution and priority treatment preferences have inevitably changed. In Turkey, the frequency of almost all upper extremity fractures except proximal humerus and humerus shaft fractures have increased significantly in the adult population, while the frequency of lower extremity fractures associated with high-energy injuries have decreased. In the pediatric population, treatment preferences are shifting towards conservative methods rather than surgery during the COVID-19 pandemic.

A comparative study of functional outcome of dynamic compression plating versus interlocking nailing for fracture shaft of humerus at tertiary care center

A comparative study of functional outcome of dynamic compression plating versus interlocking nailing for fracture shaft of humerus at tertiary care center

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

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

COMPARISON OF SINGLE- AND DOUBLE-PLATE FIXATION TECHNIQUES IN THE TREATMENT OF NONUNIONS OF THE HUMERAL SHAFT.

ABSTRACTIntroduction Humerus shaft fractures may be treated conservatively or surgically. In 2.5% to 13% of cases, nonunion is observed, and it leads to severe pain and morbidity. Plate osteosynthesis has become popular in the treatment of nonunion of the humeral shaft. In this study, we compared the clinical outcomes of patients with humerus shaft nonunion whom we treated with single- or double-plate fixation.Materials and Methods Fifty-three patients diagnosed with aseptic humeral shaft nonunion and treated with plate fixation were included in the study. Patients were evaluated according to the number of plates (single vs. double plates). The two groups were subjected to statistical evaluation according to their clinical and radiographical results.Results The average age of the patients was 53 years (range: 1-86); 28 (52.8%) were female and 25 (47.2%) were male. The union rate was 90.32% for single plate and 90.91% for double plate fixation. There was no statistically significant difference between single and double plates in the clinical and radiographical results (union time, union rate, Q-DASH score) (p > 0.05). There was a significant correlation between age and union times / Q-DASH scores according to the Spearman correlation test (p < 0.05). Transient radial nerve neuropraxia developed in 2 patients and 1 patient suffered from an infection that was treated with debridement and antibiotic therapy.Conclusion In our study, similar good results were obtained with single and double plates. In treatment of humeral shaft nonunions, a second plate is not needed if enough stability is provided with single plate fixation. Level of evidence III, Retrospective comparative study.