Ipsilateral Humeral Shaft Fracture Research Articles

Minimal invasive plate osteosynthesis for the dislocated humeral head fracture associated with ipsilateral humeral shaft fracture: A case report.

The condition combining a dislocated humeral head fracture and an ipsilateral humeral shaft fracture is seen to be rare in literature, which is limited to case report or case series. Furthermore, effective management of these coexistent injuries is still a subject of debate. The essential purpose of this article is to report another treatment method for this condition. We present a case of a 79-year-old female patient who suffered a three-part humeral head fracture-dislocation associated with the ipsilateral humeral shaft fracture. The combined injuries were managed by minimal invasive plate osteosynthesis (MIPO) through the deltopectoral approach with the eventual result of bone healing and good function after thirty-three months of follow-up. In conclusion, MIPO should be considered a safe and effective option, however, the risk of traumatic osteonecrosis of the humeral head is taken into account before operation decision-making.

A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century.

Background:Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases.Purpose:To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures.Results:Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy.Conclusion:There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.

Management of Dislocation of the Shoulder Joint with Ipsilateral Humeral Shaft Fracture: Initial Experience.

ObjectiveTo gain a better understanding of the traumatic mechanism and to develop appropriate treatment for dislocation of the shoulder joint with an ipsilateral humeral shaft fracture.MethodsThis was an observational and descriptive study. Nine patients with traumatic shoulder dislocations associated with ipsilateral humeral shaft fractures who visited the emergency room and received treatment from January 2012 to June 2018 were retrospectively analyzed. CT with three‐dimensional reconstruction was performed to provide precise anatomical information of the fractures. The traumatic event and the type of fracture of the humeral shaft were analyzed to help determine the trauma mechanism. Closed reduction of the dislocation was attempted at once under intravenous anesthesia. One patient died the following day due to unrelated causes. All humeral shaft fractures of the eight patients received internal fixation, and then reduction of the dislocation was performed again if previous attempts failed. The affected limb was immobilized in a sling for 3 weeks postoperatively, and then active and passive movement was encouraged. Patients were evaluated based on clinical and radiographic examinations, shoulder joint range of motion, Constant–Murley score, and subjective shoulder value.ResultsFour cases in the present study could not give a clear description of the traumatic procedure. The other five patients suffered a second strike on their upper arms when they were hurt, with low mobility and high pain in the shoulder region. Seven cases were simple fractures and two were wedge fractures. According to the AO/OTA classification system, four cases were type 12‐A2, three were type 12‐A3, and two were type 12‐B2. Six patients successfully obtained closed manipulative reduction of the shoulder dislocation in the acute stage. The follow‐up time ranged from 18 to 31 months. No deep wound infections were encountered. All fractures healed uneventfully. The union time ranged from 4 to 6 months. At the final follow‐up, shoulder range‐of‐motion values were found to range from 140° to 170° forward flexion, 30° to 40° extension, 40° to 45° adduction, 150° to 170° abduction, 50° to 60° internal rotation, and 50° to 60° external rotation; no recurrent instability of the shoulder joint occurred; the Constant–Murley score was 89.5 ± 3.7 points (range: 84–94 points); the subjective shoulder value was 89.4% ± 6.3% (range: 75%–95%).ConclusionShoulder dislocation most likely occurs first with an axial force or a direct posteroanterior force and a subsequent force results in the shaft fracture. For patients with mid‐distal humerus fractures, closed manipulative reduction of the joint is usually effective. After success of closed reduction, surgery for the humeral shaft fracture is advocated to ensure stability and to make patient nursing convenient. In cases with fractures in the proximal third of the humeral shaft, fixation is suggested beforehand to help reduce the shoulder dislocation.

Coincidence of Ipsilateral Humeral Shaft, Monteggia and Both Bone Fractures; A Floating Elbow with Significant Recovery

The coincidence of forearm and humeral shaft fractures results in a “floating elbow” injury necessitating surgical open reduction and internal fixation of all fractures to allocate for maintenance of elbow joint suitable motion and minimizing stiffness. Here we introduce a case of an ipsilateral humeral shaft fracture and Monteggia and both bone fracture with terrible triad open fracture from a pedestrian car accident (PCA) to his right upper extremity.

Fixation of Middle Third Humeral Shaft Fractures by Anteromedial Plate Through Anterolateral Approach

AbstractBackground: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in antero-medial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure.Aim of Study: The aim of this study is evaluation of results of fixation of middle third of humeral shaft fractures by anteromedial plate osteosynthesis through an anterolateral approach.Patients and Methods: In this prospective study, 21 cases with middle third humeral shaft fractures were treated with anteromedial plate through anterolateral approach. Clinical and radiological data were analyzed.Results: These cases were assessed according to Murphy scoring systems for middle third humerus fracture the clinical results were graded as excellent in 14 patients (66.6%), good in4 patients (19%), fair in 3 patients (14.3%) & poor in no patients (0%). The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 18 patients (85.7%), and the unsatisfactory results were found in 3 patients (14.3%).Conclusion: This study proves that anteromedial plating of middle shaft humerus through anterolateral approach is safe, effective and avoids release of deltoid tendon insertion and also avoids radial nerve dissection and its injury.

Ipsilateral humeral neck and shaft fractures

Background/Aim. Fractures of the proximal humerus or shaft are common, however, ipsilateral neck and shaft humerus fracture is a rare phenomenon. This combination injury is challenging for orthopaedic surgeons because of its complex treatment options at present. The purpose of this study was to review a series of ipsilateral humeral neck and shaft fractures to study the fracture pattern, complications and treatment outcomes of each treatment options used. Methods. A total of six patients (four female and two male) with the average age of 42.8 years (range: 36?49 years) was collected and reviewed retrospectively. Two of them were treated with double plates and four with antegrade intramedullary nail. According to the Neer?s classification, all proximal fractures were two-part surgical neck fractures. All humeral shaft fractures were located at the middle of one third. Five fractures were simple transverse (A3), one fragmented wedge fracture (B3). One patient had associated radial nerve palsy. Results. All surgical neck fractures except one united uneventfully in the average time span of 8.7 weeks. Four humeral shaft fractures healed in near anatomic alignment. The remaining two patients had the nonunion with no radiological signs of fracture healing. The average University of California, Los Angeles End-Results (UCLA) score was 23.1. On the contrary, the average American Shoulder and Elbow Surgeon's (ASES) score was 73.3. The patients treated with antegrade intramedullary nails presented 70.5 points. The ASES scores were 79 in the double plates group. Conclusions. Ipsilateral humeral shaft and neck fracture is extremely rare. Both antegrade intramedullar nailing and double plates result in healing of fractures. However the risk of complication is lower in the double plating group.

Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach.

Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure.Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. Rodriguez- Merchan criteria was used to grade the functional outcome.Results: Of the 54 patients, 28 (58.85%) were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%).The mean (± SD) duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%). Four (7.40%) patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez – Merchan criteria showed that 37(68.51%) of the patients had good and 12 (22.22%) had excellent functional outcome.

Humeral Shaft Fracture with Ipsilateral Anterior Shoulder Dislocation and Posterior Elbow Dislocation: A Case Report and Review of the Literature.

Fractures of the humeral shaft are rarely complicated by ipsilateral shoulder or elbow dislocation. While the majority of isolated humeral shaft fractures can be treated nonoperatively, polytrauma, neuromuscular disease, and pathologic fractures are often indications for operative intervention1,2. Injuries resulting in concomitant joint dislocation may be associated with functionally adverse outcomes3. Since first reported in the literature in 1940, there have been twenty-three reports in eighteen papers of humeral shaft fractures associated with anterior shoulder dislocation4. There have been even fewer reports of humeral shaft fractures with ipsilateral posterior shoulder dislocation5,6 or ipsilateral elbow dislocation7. We present a case of an extremely rare injury involving a humeral shaft fracture with ipsilateral shoulder and elbow dislocation. To our knowledge, the simultaneous dislocation of both joints in association with an ipsilateral humeral shaft fracture has been reported only once in the literature7. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-six-year-old black man arrived at our level-I trauma center. He had been struck by a forklift while trying to save a two-year-old child from being hit by the machine. He sustained a left frontal intraparenchymal subarachnoid hemorrhage with associated facial and orbital fractures. Radiographs obtained in the trauma bay and physical examination revealed a fracture of the midshaft of the right humerus with an ipsilateral anterior glenohumeral dislocation and a posterior elbow dislocation (Figs. 1-A and 1-B). Anteroposterior (AP) ( Fig. 1-A ) and lateral ( Fig. 1-B ) radiographs of the right humerus and elbow demonstrating a comminuted oblique midshaft fracture with lateral apex angulation and posterior displacement of the distal fragment. Also evident are the anterior glenohumeral dislocation ( Fig. 1-A ) and the posterior elbow dislocation ( Fig. 1-B ). Fig. 1-A Fig. 1-B While the patient was in the trauma bay, we first turned our attention to the closed joint reductions. We employed general anesthesia to relax the patient adequately. In order to take tension off of the median, ulnar, and radial nerves distally, and to give us a stable and …

Floating elbow injuries in adults: prognostic factors affecting clinical outcomes

Floating elbow fractures in adults are rare and complex injuries with unpredictable outcomes. The present study was designed to assess our experience, analyze possible compilations and illustrate prognostic factors of the final outcome. Between 2002 and 2009, 19 patients with floating elbow fractures were treated in our department (mean follow-up, 26 months). The fractures were open in 10 patients (52.6%), and concomitant nerve palsy was present in 10 patients. Although the term "floating elbow" refers only to concomitant ipsilateral humeral and forearm shaft fractures, we also included injuries with intra-articular involvement. We categorized the patients into 4 groups: group I (10 patients) included shaft fractures of humerus and forearm, group IIa (5 patients) and IIb (1 patient) included partial intra-articular injuries, and group III (3patients) involved only intra-articular comminuted fractures of the elbow region. Fracture healing was observed 14 weeks postoperatively, except in 2 patients, in which elbow arthroplasty was applied, and in 1 with brachial artery injury. Nine patients with nerve neuropraxia recovered 4 months postoperatively, and tendon transfers were necessary in 1 patient. Recovery in patients with nerve palsy was worse than in those without nerve injury (Mayo Elbow Performance Score, 73 vs 88.34; Khalfayan score, 72 vs 88.3). In addition, intra-articular involvement (groups II and III) negatively influenced the final clinical outcome compared with isolated shaft fractures (group I; Mayo Elbow Performance Score, 71.1 vs 88.5; Khalfayan score, 72.67 vs 86.1). Although the nature of floating elbow injuries is complex, the presence of nerve injury and intra-articular involvement predispose to worse clinical outcomes.

Luxation antérieure de l’épaule associée à une fracture de la diaphyse humérale homolatérale (à propos d’un cas)

The association of shoulder dislocation with ipsilateral humeral shaft fracture remains rare. Is presented along with a review of the literature regarding 18 reported cases. The prognosis depends on that of the shoulder. The authors report a case of shoulder dislocation with ipsilateral humeral shaft fracture at a patient of 34 years an accident of sport (cyclocross). After closed reduction of the anterior shoulder dislocation. The treatment was surgical, required open reduction of the humeral fracture with compression plating. At recession of one year, the clinical examination finds amplitudes comparable to the shoulder controlatéral without instability.

Dislocation of the Shoulder with Ipsilateral Humeral Shaft Fracture - A Case Report -

Dislocation of the shoulder with ipsilateral humeral shaft fracture is very rare, but serious injury that requires emergent care. There have been approximately 20 cases reported in the English literature, but it has never been reported in Korea. We report a case of dislocation of right shoulder with ipsilateral humeral shaft fracture which was successfully treated by closed reduction of the shoulder under general anesthesia and internal fixation with antegrade interlocking intramedullary nailing for the humeral shaft fracture.

A Neglected Posterior Fracture Dislocation of the Shoulder With Ipsilateral Distal Humeral Shaft Fracture

Cases of posterior dislocation or fracture-dislocation of the shoulder are rare. A combination of posterior dislocation and ipsilateral humeral shaft fracture, especially a distal third one, is even rarer. In such injuries, the diagnosis of shoulder dislocation may be missed because great attention is usually given to the fractured humerus. We present this case report to raise awareness among emergency physicians of this manner of injury. We present a case report of a 30-year-old woman who had posterior fracture dislocation of the right shoulder with ipsilateral distal humeral shaft fracture. The shaft fracture was initially evaluated, internally reduced, and fixed, whereas the posterior fracture-dislocation of the shoulder was not recognized. A belated diagnosis was established 1 month after the operation, when a computed tomography scan was performed because the patient reported continuous pain and limited range of motion of the shoulder. A second reduction was performed to reduce the dislocation. The patient had partial functional recovery 1 year later. Consideration of this condition, coupled with thorough and appropriate physical and radiological examinations, could lead to improved recognition of such cases.

Dislocation of the shoulder joint with ipsilateral humeral shaft fracture: two case reports

A combination of the shaft fracture of the humerus with shoulder dislocation is a rarely documented injury. Moreover, few reports describe a long-term outcome after a follow-up period over 10 years. The present article is the first report of long-term clinical results obtained with this combined injury. We present two cases of the dislocation of the shoulder joint with ipsilateral humeral shaft fracture. One is an anterior dislocation and the other is posterior. The anterior dislocation was closely reduced on the date of injury, but the posterior dislocation required open reduction 6 weeks after the injury because it was missed at the initial diagnosis and identified 4 weeks after the injury. In the latter case, shoulder pain and limitation of the motion persisting after the first surgery had to be treated by anterior acromioplasty and arthrolysis of the shoulder. In both cases, the humeral fracture was fixed by retrograde intramedullary nailing using a Küntscher nail and successful bone union was achieved. At over 10-year follow-up examination, both patients had no limitation in activities of daily living and no restrictions to their normal occupation. The radiographs of the shoulder joint demonstrated good clinical results, with no degenerative change or osteonecrosis. We have experienced two cases of dislocation of the shoulder joint with ipsilateral humeral shaft fracture and reported long-term results over 10 years. Good clinical results were demonstrated in both cases.

Unreduced Chronic Dislocation of the Humeral Head With Ipsilateral Humeral Shaft Fracture

The purpose of reporting this case is to illustrate a treatment plan for a chronically anteriorly dislocated shoulder associated with an ipsilateral humerus fracture, a condition heretofore not addressed in the literature to our knowledge. An 18-year-old female, left hand dominant, injured her left upper extremity and liver in a motor vehicle accident. X-rays at time of injury revealed a diaphyseal facture of her left humerus. No x-rays of the shoulder were taken at time of injury. Treatment consisted of a plaster cast application and discharge at 1 week. The patient was seen again 4 weeks postinjury, at which time only humerus films were taken and the immobilization was continued. At 45 days postinjury, the patient complained of left shoulder pain, and shoulder x-rays at that time revealed an anterior subcoracoid dislocation of the left humeral head. At surgery 52 days postinjury, the humeral shaft fracture was found to be unstable and external fixation of both the fracture (2 pins above and below the fracture) and the reduced but still unstable humeral head was performed (a pin through the humeral head into the glenoid). The external fixator was removed at 3 weeks, and at a 3-year follow-up, the patient had acquired nearly full range of motion of her shoulder without pain and no significant limitations of her arm movements or activities. In conclusion, given a patient with a chronic anteriorly dislocated shoulder and a healing ipsilateral shaft fracture, an external fixation stabilization of both the fracture and the relocated repaired dislocation is a viable treatment option.

Locked posterior dislocation of the shoulder with ipsilateral humeral shaft fracture—a management option

Locked posterior dislocation of the shoulder withipsilateral humeral shaft fracture following traumais a rarely reported condition. More widely reportedare cases involving anterior dislocation with ipsilat-eral humeral shaft fractures or posterior shoulderdislocationsalone.Areviewoftheliteraturerevealsbothnon-operativeandoperativemanagement.Thiscase presents a management option involving openreduction of the shoulder dislocation acutely withinternal fixation of the humeral shaft fracture.

Nonunion of a humeral shaft fracture after unrecognized longstanding posterior shoulder dislocation

Problems relating to unrecognized posterior dislocation of the glenohumeral joint have been well described.7,14,17 Delayed recognition of this injury often leads to significant shoulder dysfunction and presents considerable difficulty in treatment. Although acute concomitant fractures of the glenoid and proximal humerus are relatively common, ipsilateral humeral shaft fractures with posterior dislocation are rare injuries.1,9,13,17 Successful outcomes have been reported in cases in which these injuries were addressed acutely. No previous authors have reported a case in which a humeral shaft fracture occurred with an unrecognized chronic posterior shoulder dislocation. We describe a complex case of humeral shaft fracture and development of a subsequent nonunion, largely contributed to by an unrecognized chronic posterior shoulder dislocation. Presented are a discussion of this unique case and a review of relevant literature regarding treatment for chronic posterior shoulder dislocation.

Dislocation of the shoulder with ipsilateral humeral shaft fracture

Dislocation of the shoulder with ipsilateral humeral shaft fracture

Posterior dislocation of the shoulder with ipsilateral humeral shaft fracture: a very rare injury

A third case of a posterior dislocation of the shoulder with ipsilateral humeral shaft fracture is described. It is recommended that this dificult management problem requires internal fixation of the humeral shaft fracture to allow control of the shoulder.

Skeletal Management of Humeral Shaft Fractures Associated with Forearm Fractures

Nine cases of ipsilateral humeral shaft and forearm fractures in multiply injured patients were reviewed in an attempt to ascertain the preferred management of these complex injuries. Satisfactory anatomic and functional results were achieved only in those cases treated by rigid internal fixation of the humeral fractures. Nonoperative management is associated with a significant risk of malunion or nonunion of the humerus.