Management Of Humeral Shaft Fractures Research Articles

Humeral Shaft Fractures: Surgical versus Nonsurgical Management in Workers' Compensation.

The optimal surgical indications for humeral shaft fractures in the working population remain uncertain. This study investigates the impact of surgical fixation on return to duty, union, and complications in workers' compensation patients with humeral shaft fractures. All workers' compensation patients with humeral shaft fractures managed at a single institution between 2007 and 2017 were identified. Manual chart and radiographic review was performed to identify etiology of injury, type of work, time until return to duty, length of physical therapy, complications, and time to fracture union. There were 39 humeral shaft fractures in workers' compensation patients managed at our institution (25 surgical; 64.1%). There was no difference in the return to light (106.1 versus 60.4 days; P=0.20) or full (140.1 vs. 139.9 days; P=0.99) duty for surgical versus nonsurgical treatment, respectively. There was no difference in the length of physical therapy (132.6 versus 106.3 days; P=0.15) or time to maximum medical improvement (174.3 vs. 198.8 days; P=0.25) for surgical versus nonsurgical treatment, respectively. Three patients returned to the operating room in the surgical group. Nonunion was observed in two surgical cases (8.0%) and one case (7.1%) of nonsurgical management. This study did not identify an advantage for faster return to work after surgical management of humeral shaft fractures in workers' compensation patients. Though one of the perceived advantages of surgical fixation is a quicker return to physical activity, there may be other variables in this patient population that influence the timing of return to work.

Comparing fin intramedullary nailing with standard locked intramedullary nailing in the fixation of humeral shaft fractures

Background: Standard interlocking intramedullary nailing of the humeral shaft fractures has its attending complications such as difficulty in locking the nail distally and associated nerve injuries. Aim: To compare the rate of fracture healing, functional outcome and complication rate between SIGN standard locked intramedullary nail (SSLIN) and SIGN intramedullary fin nail (SIFN) in the management of humeral shaft fractures. Method: This is a retrospective comparative study comprising of patients who were treated with either SSLIN or SIFN for humeral shaft fractures. They were followed up until full activities of daily living was achieved. Data collected were processed with SPSS. Comparisons were made between the two groups using student t-test for the continuous variables and Chi-square for the categorical variables. Results: Forty-three patients with humeral shaft fracture were included in this study. Thirty-one of them constituted the SSLIN group while 12 of them constituted the SIFN group. At 6 weeks, radiographic evidence of fracture healing was seen in 64.5% and 58.3% of the patients in the SSLIN and SIFN groups respectively and by the third month, 96.8% and 100% of the patients respectively had achieved radiographic evidence of fracture healing. The differences were not significantly different. There was also no significant difference in the findings from the comparative assessment of functional outcomes in both groups. Conclusion: SIFN compared favorably with the SSLIN in terms of rate of fracture healing and resumption of functional activities. SIFN is therefore encouraged to be used for humeral shaft fractures.

Surgical management of diaphyseal fractures of the humerus with plate osteosynthesis on anteromedial surface

Background: Humeral shaft fractures represent approximately 1-5 % of all fractures. Non-operative management of humeral shaft fractures is the mainstay of treatment with some drawbacks. The surgical options for a closed humerus diaphyseal fracture are plate osteosynthesis and intramedullary nailing, the previous being gold standard for last four decades. The aim of this study is to evaluate the union rates and functional outcome of anteromedial plate fixation in diaphyseal fractures of the humerus.Materials and Methods: 56 patients treated in a tertiary care medical teaching hospital between June 2015 and May 2019 were enrolled in the study. The humerus was approached by Henry`s approach, fractures were reduced and fixed with 4.5 mm narrow DCP or LCP on the anteromedial surface. All patients were followed up for minimum of 6 months. Modified Stewart and Hundley scoring was used to grade the outcome.Results: Out of 56 patients 41 were males and 15 females, with mean age of 36.5 years. Road traffic accidents were the most common mechanism of injury. The most common fracture pattern was A3 followed by A2. The average time taken for fracture union was 13.8 weeks. 44 patients had excellent to good functional outcome. Three patients had delayed union and one had non-union. None of the patients had iatrogenic radial nerve injury.Conclusion: Plating on anteromedial surface using an anterolateral approach is very good technique for management of humerus shaft fractures with good functional outcome and lesser incidence of radial nerve injury.

Evaluating the Outcome of a New Functional Brace for the Management of Humeral Shaft Fractures

Background:Our practice identified several issues with the commercially available plastic off-the-shelf Sarmiento brace that is used in managing humeral shaft fractures, with regards to comfort, moulding, and ability to hold reduction. A custom-moulded fibreglass brace was developed which was soft padded for comfort, lightweight, and could be adjusted with changes in swelling.Objective:The aim of this study was to evaluate the use of this new brace.Methods:16 patients were identified having treatment with the brace from March 2011 to July 2013. Retrospective analysis of medical records and imaging occurred to assess union and angulation. Prospective analysis of patient function was assessed with the CONSTANT, DASH and SPADI Shoulder score.Results:Patients were initially managed with a U-Slab for an average of 26 days. Patients were followed up for an average of 70 days post brace application. 5 patients were lost to follow up. The remaining 11 patients had the brace on for an average of 73 days. In the last follow up, 15 patients had an acceptable anterior/posterior angulation of less than 200(1 patient - 220), varus/valgus angulation less than 200, and less than 3cm of shortening. 12 patients had radiological evidence of union, with the other 4 demonstrating significant callus. 4 patients were recruited for prospective analysis with DASH, SPADI and CONSTANT shoulder scores, and demonstrated minimal loss of function. There were no complications of bracing treatment.Conclusion:Our new functional brace led to bony union in most patients, and from a clinical perspective, most patients were pain free and had minimal loss of function.

HUMERAL SHAFT FRACTURES

Objectives: To determine the functional outcome of operative management of humeral shaft fractures. Study Design: Prospective cohort study. Place and Duration: At the Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi, for a duration of 02 years from 12th January 2016 to 11th January 2018. Patients and Methods: 45 patients presenting with humeral shaft fractures and meeting the inclusion criteria were included. All patients underwent fixation with a Dynamic Compression Plate (DCP). Functional outcome assessed at six months post-operatively using the American Shoulder and Elbow Surgeons Scoring System (ASES). Results: Mean age of patients included in the study was 34.6 ± 10.3 years.Out of the 45 patients, 31 (68.9%) were males and 14 (31.1%) females. Pre-dominant condition resulting in operative management was humeral shaft fracture in poly trauma patients (n=27, 60%). Shoulder functioning following surgery was good with a mean ASES score of 81.1±10.6. Conclusion: Plating in humeral shaft fractures results in a good functional outcome postoperatively.

Minimally Invasive Plate Osteosynthesis of Humeral Shaft Fractures: Current State of the Art.

Most closed humeral shaft fractures can be successfully managed nonsurgically. However, fractures for which closed treatment is unsuccessful are stabilized using either plates or intramedullary nails. There are shortcomings associated with each technique, including the potential complications of nonunion, infection, shoulder pain, and radial nerve injury. Minimally invasive plate osteosynthesis (MIPO), an innovative alternative treatment, is gaining in popularity. This technique is based on the anterior humeral shaft providing a relatively safe surface for plate application, and limited open exposures proximally and distally allow percutaneous insertion of the necessary implant. More than 40 articles have been published regarding MIPO, and it compares favorably to other available forms of treatment with excellent functional outcomes and a lower rate of iatrogenic radial nerve injury. Larger randomized controlled trials comparing this method with other accepted techniques, including nonsurgical management, are necessary to better define the role of MIPO in the management of humeral shaft fractures.

Study of effectiveness of interlocking nail in management of fracture shaft humerus

Background & Objectives: Operative management of humeral shaftfractures can be with plate osteosynthesis or with intramedullary nailing. As the intramedullary nails can be introduced in a closed manner, they preserve the fracture hematoma, providing early fracture consolidation with higher union rates and low infection rates. Interlocking achieves rotational stability providing early mobilization of the neighbouring joints. But, with antegrade nailing they do have a disadvantage of causing shoulder stiffness. In this study we have tried to analyze the outcome in terms of time for consolidation, union rates, functional results and complications of humeral shaft fractures managed with intramedullary nailing. Methods: 20 adult patients with acute humeral shaft fractures were treated withclosed intramedullary nailing in antegrade manner. There were 15 males and 5 females with an average age of 35.75 years (21-60 years). All the patients were followed over a period of 2 years and results were analyzed. Results: 17 (85%) fractures united with a average consolidation time of 13.5 weeks (10-16 weeks), 2(10%) fracture ended in delayed union which needed bone grafting.1(5%) case needed redoing with plate osteosynthesis due to severe nail prominence. There was no case of iatrogenic radial nerve palsy. Nail impingement was seen in 4(20%), shoulder stiffness in 1(5%) and none of the patients got infected. Functional results were excellent in 15(75%), moderate in 4(20%) and poor in 1(5%). Conclusion: Closed intramedullary nailing offers a safe and reliable method offixing humeral shaft fractures, with early fracture consolidation and higher union rates. It provides early rehabilitation and reduces the hospital stay.

Outcome of open reduction and internal reduction with plating in fractures of shaft of humerus

Background and Objectives: Fractures of shaft of humerus consists of 1% - 3% of all fractures. Despite the numerous surgical modalities, plate osteosynthesis remains the gold standard for fixation of humerus shaft fractures. The aim of this study is to see the functional results of humerus shaft fractures treated with plating, reemphasizes the effectiveness of plate osteosynthesis in the management of humeral shaft fractures so as to restore the patient structurally and functionally to near normal status. Materials and Methods: This is retrospective and prospective study of 30 cases of fractures of shaft of humerus admitted at S.S.G. Hospital, Vadodara, Gujarat in between july 2015 to june 2016. Cases were sleceted as per inclusion and exclusion criteria. All patients were operated using posterior or anterolateral approach. They were assessed radiologically and clinically for fracture union at regular intervals of 6 wks, 12 wks and 18wks by using DR. R.N. Deweshwar’s Score.Results: Our study of 30 cases, there were 25 men and 5 women, with average age of 39 years.16 (53.33%) patients were admitted due to fall from height,12 (40%) due to road traffic accidents and 2 (6.66%) patients due to assult with predominance of right side 20(66.66%) patients. Out of 30 cases 21(70%) patients of middle third, 7 (23.33%) were lower third, and 2 (6.66%) were upper third. 28 patients having close fractures and 2 have open injury. simple transverse fractures were most common that is 12(40%).10 (33.33%) patients were having associate injuries. The fracture united in 29(96.66%) patients with 1 (3.33%) patient going for non union. Good and full range of shoulder and elbow movements was present in 28 (93.33%) patients with 2 patients having fair shoulder range of movement and 2 patients having fair elbow range of movement. Conclusion: Open reduction internal fixation with plating is an excellent mode of treatment in fracture of shaft of humerus, which consistently gives long term good results.

Comparitive Study of Surgical Management of Humeral Shaft Fractures with D.C.P by Henry's and Thompson's Approach in Adults

Comparitive Study of Surgical Management of Humeral Shaft Fractures with D.C.P by Henry's and Thompson's Approach in Adults

Socioeconomic Deprivation and the Outcome of Non-Operative Management of Humeral Shaft Fractures

Socioeconomic Deprivation and the Outcome of Non-Operative Management of Humeral Shaft Fractures

Comparative study of operative management of humeral shaft fractures by dynamic compression plating versus locked intra-medullary nailing

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Operative management of humeral shaft fractures is mostly accomplished by surface plating or intra-medullary nail osteosynthesis. Both the treatment options have been variably reported to give good rates of union and functional outcome. We compared both the options to know the better one in multitude of variables.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Thirty patients with fracture shaft of humerus were followed up for a period of 12 to18 months. 15 patients each underwent open reduction and internal fixation with dynamic compression plate and closed antegrade locked intra-medullary nailing. All patients were clinically and radiologically assessed till fracture union</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Diaphyseal humeral fractures in all the patients treated with nailing united and had a tendency to unite early compared to plating. Shoulder pain was initially complained by 2 patients from the nailing group and got subsided later on. The incidence of complications was more in the plate osteosynthesis group. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study Intra-medullary nailing turned out to be superior to plating for amenable diaphyseal fractures of humerus in terms of higher rate of union, early union and lesser complications.</span></p>

Humeral shaft fractures: national trends in management

BackgroundThe incidence of humeral shaft fractures has been increasing over time. This represents a growing public health concern in a climate of cost containment. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention.Materials and methodsHumeral shaft fractures were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 812.21 and 812.31 in the United States Nationwide Inpatient Sample from 2002 to 2011. Open reduction and internal fixation (ORIF) was identified by code 79.31 (ORIF, humerus). Other case codes analyzed were 79.01 (closed reduction without internal fixation), 79.11 (closed reduction with internal fixation), and 79.21 (open reduction without internal fixation). Multivariate regression analysis was utilized to determine predictive factors for utilization of ORIF.Results27,908 humeral shaft fractures were identified. Utilization of ORIF increased from 47.2% of humeral shaft fractures in 2002 to 60.3% in 2011. Demographically, patients who underwent ORIF were younger (51.5 versus 59.7 years, p < 0.001; odds ratio 0.87 per decade of age). There were modest increases in ORIF usage with private insurance, open fracture, and hospital size, which persisted with multivariate regression analysis. Surprisingly, there was a tendency to shift from a slight increase in ORIF for males with the bivariate case to a slight preference for females in the multivariate case.ConclusionUtilization of ORIF for humeral shaft fractures has been steadily increasing with time. Surgical intervention was more common with younger patients, female gender, private insurance, and larger hospital size. The increasing incidence of surgical management for humeral shaft fractures may represent a public health burden given the historical success of non-operative management.Level of evidenceIV.

Comparative study of surgical management of humeral shaft fractures with dynamic compression plate in Henry’s and Thompson’s approach in adults

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of the humeral shaft account for roughly 3% to 5% of all fractures. The predominant causes of humeral shaft fractures include simple falls or rotational injuries in the older population and higher energy mechanisms in the younger patients including motor vehicle accidents, assaults, fall from height and throwing injuries. Treatment options for humeral fractures vary according to the type of fracture, age group, bone density, soft tissue status and associated complications. Surgical management of shaft humerus fractures by plating can be done mainly through Thompson’s (posterior) approach and Henry’s (antero-lateral) approach.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted in patients treated for shaft humerus fracture at Adhichunchanagiri Institute of Medical Science, BG Nagara from the month of August 2014 to January 2016. Twenty patients diagnosed as shaft humerus fracture were taken into the study, all were undergone open reduction and internal fixation using dynamic compression plate in Thompson’s and Henry approach. Patients’ age more than 18 years were taken up for the study. Patients were followed up at 3 weeks, 6 weeks, 6 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The sample consisted of twenty shaft humerus fracture patients with 10 males and 10 females. The patients’ ages were more than 18 years where 13 cases (65%) between 26 to 55 years. Among these 20 patients, 10 involved the right side and 10 involved the left side. All patients achieved clinical and radiological union at 6 month follow up. According to Constant Murley Score, excellent result were found in 11 patients (55%), good in 2 patients (10%) and fair in 7 patients (35%). According to Mayo elbow performance index, 17 patients showed excellent outcome (85%) and 3 patients showed good outcome (15%).&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt;Dynamic compression plating is the best modality of management for the internal fixation of humeral shaft fractures. It is found that the fracture fixation of upper and middle one-third humerus in Henry’s approach is easier, lower one-third humeral fractures are not possible because the plate at the supracondylar ridge poses difficulty to fix. Fracture fixation of the lower one third and middle one third is easier in Thompson’s approach because of the flat surface of the bone and offers better plate contour.&lt;p&gt; &lt;/p&gt;

A study of humerus shaft fractures treated with dynamic compression plating

Background and Objective: Management of humeral shaft fractures has historically been largely conservative. A significant body of literature has shown that functional bracing may achieve greater than 90% union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopedic surgeons are increasingly likely to consider surgical intervention.The objective of this study is to assess the functional and radiological outcome of Humerus shaft fractures in adults treated by open reduction and internal fixation with Dynamic Compression Plate. Materials and Methods: This study was done mainly as a prospective study with some data collected retrospectively among patients admitted for fracture shaft of Humerus at tertiary care hospital between August 2013 to July 2015. 30 patients underwent open reduction and internal fixation with dynamic compression plating. In our study we have used a scoring system invented by Dr. Rajiv N. Daveshwar for calculating result. Results: Present study was comprises of 30 patients with humeral fracture with the mean age of 37.93 years and male/ female ratio of 5:1. Excellent result was seen in 22(73.34%) cases, 6(20%) cases had good results while fair result was found in 2 cases (6.66%). None of our cases showed poor results. Complications were seen in 5 patients of which 1 had non-union and 4 developed joint stiffness. Pre-operative traumatic Radial Nerve Palsy was found in 4 patients of which 2 recovered eventually while 2 did not. Conclusions: It is concluded that internal fixation with plating is the good option for the fixation of diaphyseal Humerus fracture. Radial nerve palsy is less likely if isolated during operation.

Management for Locking Compression Plate/Dynamic Compression Plate Implant Failure in Non Union Osteoporotic Humerus Shaft Bone Fracture

Abstract Introduction To introduce the experience of treating nonunion osteoporotic of humeral fractures with interlocking nailing for failed surgical treatment by plating. Etiology for non-union after failed surgical management of humeral shaft fractures is multi-factorial. Following factors may play a role in nonunion – inadequate fracture fixation with poor contact between the fracture segments, osteomalacia, osteoporosis, infection, devitalization of bone and many more. Materials and methods A retrospective comparative study of twenty four patients who had locking compression plate failure in osteoporotic humerus shaft fractures treated with interlocking nail and iliac crest bone graft at Gandhi Hospital from 2007 to 2010. Results Twenty extremities had a return to nearly normal function within twelve weeks after nailing. According to Rommens criteria excellent results seen in 79.2%, moderate 16.7%, poor 4.1%. The mean Constant-Murley score improved from pre operative 45.9 ± 17.6 to 79.1 ± 12.6 (p Conclusion Interlocking intramedullary nailing of the humerus provides immediate stability and can be accomplished with a closed technique, brief operative time, and minimum morbidity, with a resultant early return of function to the extremity. LEVEL OF EVIDENCE: iii retrospective cohort study.

Humeral shaft fractures: results of operative and non-operative treatment.

There has been little direct comparison between non-operative and operative management of humeral shaft fractures. The present study aimed to compare union rates and complication rates between these two modalities of treatment. A retrospective cohort study was performed at a regional level 1 trauma centre. A total of 296 patients with humeral shaft fractures met inclusion criteria; 69 patients were treated with a functional brace and 227 with surgical intervention. The primary end point was radiographic union. Nonunion was defined as failure of radiological union at sixmonths, requiring surgical intervention. Time to union, nerve palsy rate, and rate of infection were also examined. The nonunion rate was significantly higher in the non-operative group (23.2% vs 10.2%) despite higher rates of open fractures and high energy mechanisms of injury in the operative group. No significant difference in time to union was found. Nerve palsy was more common in the operative group (20% vs 39%); however, only two cases (1%) of radial nerve palsy in the operative group were iatrogenic and both were transient. Infection rates were higher for the operative group (3.5% vs 0%). Conservative treatment of humeral shaft fractures has a higher rate of nonunion, while operative treatment is associated with a low incidence of iatrogenic nerve palsy but higher rates of infection.

Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing.

The objectives of this study were to retrospectively investigate the clinical and radiological outcome of humeral shaft fractures treated by ESIN in children <16years old and to evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH(®)). We retrospectively evaluated children with fractures of the humeral shaft, surgically treated by ESIN. All the patients were regularly followed clinically and radiographically for at least 1year after their index surgery. After hardware removal, the patients were asked to answer the short version of the Disabilities of the Arm, Shoulder and Hand Outcome questionnaire (Quick DASH). Thirty-eight patients met the inclusion criteria. Mean age at the time of trauma was 11.1years. Mean follow-up was 30months. All fractures healed, but three patients had a residual valgus of >10°, two a residual varum of >10°, four a residual recurvatum deformity of >10°, and one a residual procurvatum deformity of >10°. Four complications were observed. Functional outcome was nevertheless good in all the patients, with a mean Quick DASH(®) score of 3. The study shows good clinical and functional outcomes in children and adolescents with closed isolated fractures of the humeral shaft surgically treated by ESIN, even with ensuing mild residual frontal and sagittal plane deformity. However, conservative treatment has also been advocated in the scientific literature for this type of injuries, and surgical treatment should not be considered as the only option for the management of humeral shaft fractures in older children and adolescents.

Management of Humeral Shaft Fractures; Non-Operative Versus Operative.

Context:Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. There is an increasing trend in the literature to perform operative fixation of these fractures.Evidence Acquisition:The aim of this systematic review was to compare the level one evidence for the outcome of non-operative with operative management of humeral shaft fractures in adults. A comprehensive electronic literature search of Medline and PubMed was performed with specific inclusion criteria to identify randomized controlled trials.Results:In total, seventeen different studies were identified from the search terms and combinations used. Only one study met the inclusion criteria; however, this was a published study protocol of an ongoing trial currently being conducted. One additional published protocol for an ongoing trial was also identified, but this was for a prospective comparative observational study. Although this latter study may not be level one evidence, it would offer great insight into the functional outcome of humeral shaft fractures and economic implications of operative management, which is currently not addressed in the literature. Two retrospective comparative studies were also identified, one of which demonstrated a significantly lower rate of nonunion and malunion in those patients undergoing operative management.Conclusions:This systematic review demonstrated a deficiency in the current literature of level one evidence available for the management of humeral shaft fractures. The current ongoing randomized control trail would offer a greater insight into the management of humeral shaft fractures and help confirm or refute the current literature. If this randomized control trial affirms the reduction in the rate of nonunion with operative fixation, a cost economic analysis is essential. As it would seem to offer operative management to all patients may be over treatment and not to offer this at all would undertreat.

Acute Operative Management of Humeral Shaft Fractures: Analysis of the National Trauma Data Bank.

Advances in surgical techniques have increased the role of early surgical intervention for isolated diaphyseal humerus fractures. The goal of this study was to investigate the following: (1) the current trend of operative treatment; (2) factors that affect surgical treatment; and (3) the effect of surgical fixation on length of stay, complication rates, and hospital disposition. The National Trauma Data Bank from 2004 to 2006 was analyzed. All patients with multiple injuries that included closed humeral shaft fractures and all patients with isolated humeral shaft fractures were included. Of 2312 total closed humeral shaft fractures, 1662 had a documented procedure code. A total of 47% of patients underwent surgical treatment. Surgically treated patients were on average 3.5 years older than those treated nonoperatively (P=.007). A total of 49% of white patients underwent early surgery vs 39% of nonwhite patients (P<.001). The operative group had a mean Injury Severity Score of 8.33 vs 9.0 in the nonoperative group (P=.04). Treatment at a Level I trauma center decreased the likelihood of surgery compared with treatment at a non-Level I trauma center (45% vs 57%, P<.001). Mean length of stay was 4.6 days for operative treatment vs 3.9 days for nonoperative treatment (P=.02). Of patients who underwent surgery, 78% were discharged to home compared with 69% of those managed nonoperatively (P<.001). Acute operative management of humeral shaft fractures correlated with a lower Injury Severity Score, a decreased length of stay, and less rehabilitation placement. Furthermore, older patients, white patients, and patients treated at a non-Level I trauma center were more likely to undergo acute surgical management. The reasons for these disparities are unclear and warrant further investigation.

Treatment of humeral shaft fractures by a single elastic stable intramedullary nail in children

Objective The aim of this study was to assess the effectiveness of intramedullary fixation of displaced humeral shaft fractures in skeletally immature children using a single elastic stable intramedullary nail. Background Almost all pediatric humeral shaft fractures can be treated successfully using closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. In this study, the functional and radiological results of the management of humeral shaft fractures in children using a single retrograde elastic intramedullary nail will be evaluated. Patients and methods Twenty pediatric patients ranging in age from 6 to 16 years (mean age 10 years) were treated surgically using a retrograde single elastic intramedullary nail. Relative surgical indications included open fractures, inability to maintain an acceptable reduction, concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Among the patients, 16 were males and four were females. Results The patients were followed for a mean of 5.5 months, with a range from 4 to 6 months. Radiographically, all fractures healed in good alignment. Solid union occurred from 5 to 10 weeks, with a mean of 8 weeks. There were no intraoperative complications, including neurologic or vascular injury, and two patients developed superficial wound infections postoperatively. Conclusion It was found that single elastic intramedullary nail fixation with the aid of a functional arm brace is an adequate technique for the treatment of humeral shaft fractures in pediatric patients when surgical stabilization is indicated. This simple minimally invasive technique provides stable fixation, with minimal soft tissue stripping at the fracture site, and led to bone union in all the cases studied. Level of evidence Case series, level IV.