Outcome Of Humeral Shaft Fractures Research Articles

A Retrospective Analysis of Functional and Radiographic Outcomes of Humeral Shaft Fractures Treated Operatively versus Nonoperatively

A Retrospective Analysis of Functional and Radiographic Outcomes of Humeral Shaft Fractures Treated Operatively versus Nonoperatively

Comparing the Clinical and Radiographic Outcomes of Humeral Shaft Fractures by Treatment Type.

Humeral shaft fractures are common orthopedic injuries, representing 1-5% of all fractures. There is conflicting literature regarding the superiority of operative versus nonoperative treatment of these fractures. The purpose of this study was to examine functional outcomes and time to radiographic union in humeral shaft fractures with the hypothesis that both would be improved in patients treated operatively relative to those treated nonoperatively. This retrospective cohort study examined patients with humeral shaft fractures treated at a single large healthcare system between 2010 and 2020. A chart and radiograph review were performed to collect information on demographics, fracture, treatment, and outcome information. These measures were compared between patients treated operatively and nonoperatively. Five hundred seventeen adult patients meeting inclusion criteria were identified; 233 were treated nonoperatively, and 284 were treated operatively. The mean patient age was 50.2 years in those who underwent surgery relative to 59.9 years in those treated without surgery (P<0.001). Operatively-treated patients had significantly faster time to radiographic union at a median of 113 days compared to a median of 161 days in nonoperatively-treated patients (P=0.001). The operative group was made weight-bearing as tolerated significantly faster than the nonoperative group (84 days versus 98 days, respectively, P=0.002). No statistically significant difference was seen between the two treatment groups in rates of complications or range of motion at the time of radiographic union. However, patients who underwent surgery were found to be up to two times more likely to achieve full shoulder forward elevation by the time of their final follow-up than those treated without surgery (P=0.011). Patients with humeral shaft fractures treated operatively have faster time to union, earlier weight bearing, and no change in the rate of complications compared to patients treated nonoperatively.

Comparison of Treatment Outcome of Humeral Shaft Fractures Treated with Functional Cast Brace and "U" Slab

Objective: To compare the outcome of humeral shaft fractures treated by functional cast brace versus "U" slab in terms of union. Study Design: Quasi-experimental study Place and Duration of Study: Department of Orthopaedic Surgery/Traumatology Unit-II, Mayo Hospital, Lahore, Pakistanfrom Jul to Dec 2018. Methodology: One hundred and four patients fulfilling inclusion criteria were included. Patients were randomised into two groups by random tables. Group-A patients were treated with a "U" slab outdoors, and Group-B patients were treated with a customised functional brace from the Orthopaedic workshop as indoor cases. Results: The mean age of patients was 47.99±14.15 years, with minimum and maximum ages of 16 and 65 years, respectively. According to the operational definition, the union was achieved in 88(84.6%) patients. In Group-A, 38(73.1%) patients and in Group-B, 50(96.2%) patients had union. A significant association between union and study Groups was noted, i.e. Group B had a high union rate when compared to Group A, with a p-value of 0.001. Conclusion: To conclude, in patients with humeral shaft fracture, a functional cast brace is a better choice for achieving union as it reduces the burden of non-union, and patients recover early, assessed by callous formation.

Evaluation of Humeral Shaft Fracture Outcomes by Treatment Method: A Systematic Review and Meta-analysis Based on Comparison Studies.

The purpose of this systematic review and meta-analysis was to evaluate various outcomes of humeral shaft fractures treated with different treatment methods, which included functional bracing, open reduction and internal fixation, intramedullary nailing, and locked compression plate. A systematic review was performed using research databases including PubMed, EMBASE, and Google Scholar. Keywords relating to treatment of humeral shaft fractures were used, and comparison studies that reported patient characteristics and outcomes, including nonunion, malunion, function scores, and complications, were included. One hundred fourteen records were screened, with 18 studies ultimately included in the meta-analysis. Treatment groups were consolidated into brace or surgery and then further categorized into subgroups based on surgical technique used. Postoperative events, complications, and functional scores were compared among the treatment groups. Statistical analysis for this study was conducted using Review Manager 5.3, with a standard p-value of ≤0.05 for statistical significance. Eighteen studies were included in this review with a total of 706 patients. Z-tests showed that risks of revision, nonunion, and malunion were higher in the brace treatment group compared with the surgical treatment group (p < 0.0001, <0.0001, 0.004, respectively). Risk of infection was expectedly higher in the surgical group compared with the brace group (p = 0.04). Radial nerve injury rates were also higher in the unspecified surgical group compared with the brace group (p = 0.01). In the surgical group, the mean Constant shoulder score was also significantly higher than that in the brace group (p = 0.004). When comparing the nail and plate groups, Z-tests revealed higher risks of delayed unions and other complications in the nail group (p = 0.04 and 0.001, respectively) but higher risk of infection in the plate group (p = 0.05). The conservative treatment of humeral shaft fractures with functional braces may be associated with a lower incidence of infection and nerve injury when compared with operative treatment methods. However, nonoperative treatment may also come with higher risks of revision, nonunion, and malunion than the many available surgical modalities. Operative management with either intramedullary nail or plate has shown to be a reliable method of management with reasonable outcomes for humeral shaft fractures. While the nail group had higher risk of delayed unions and other complications, the plate group had higher risk of infections. Both nail and plate surgical treatments have shown to result in high union rates and should be considered by the surgeon on a case-by-case basis when treating humeral shaft fractures. Level I. See Instructions for Authors for a complete description of levels of evidence.

To Study Functional Outcome of Humeral Shaft Fractures Treated by Intramedullary Nailing Versus Dynamic Compression Plating at a Tertiary Health Care Centre

Background: The proportion of humeral shaft fractures being treated conservatively reportedly varies from 33% to 95%. Nonsurgical treatment results in higher incidence of union and fewer complications than open reduction and internal fixation. Aims and Objectives: To study and compare the functional outcome of Dynamic Compression Plating and Interlock Nailing for humeral shaft fractures. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of sixty cases over a span of 36 months – October 2018 to December 2020. Study was carried out on cases of humeral shaft fractures requiring operational intervention in department of orthopaedics of tertiary care centre in Maharashtra. Results: A total of 76.7% cases in plating group had excellent outcome as compared to 56.7% in nailing group. Also poor to fair outcome was noted more in nailing group (13.4% vs 10%). Conclusion: Statistically comparable results have been observed for patients undergoing surgical intervention for humeral shaft fractures among locking plating and intramedullary nailing. Both provide excellent and favourable results in terms of union and function, however a higher rate of excellent results and tendency for union was seen with dynamic compression plating group.

Clinical results and functional outcome of humeral shaft fractures treated with MIPO technique

Introduction: The pursuit of anatomical reduction in fracture fixation has been replaced by anatomic alignment and biologic fixation. Minimally invasive plate osteosynthesis (MIPO) is one such biological method. The aim of this study was to evaluate the clinical results and functional outcome of humeral shaft fractures treated with MIPO technique. Material and Methods: A hospital based prospective serial follow up study was conducted. We enrolled 30 patients for our study with displaced humeral shaft fractures, which were fixed by the technique of closed reduction and minimally invasive plate osteosynthesis (MIPO). Patients were followed-up for a period of 6 months. Different parameters were evaluated at follow up visits. Functional evaluation was done by UCLA (University of California & Los Angeles) scoring for shoulder and Mayo Elbow Performance Score (MEPS) for elbow. Results: 83.33% patients had anatomical alignment at 6 months. 6.67% had less than 5° varus angulation, 10% had less than 5 ° valgus angulation. 5 patients (16.67%) had radial nerve injury. 63.33% patients had excellent UCLA scores at 6 months. Majority of the patients (93.33%) had excellent MEPS scores. Conclusion: Our study supports that MIPO is a decent method of treating humeral shaft fractures but it requires adequate imaging and surgical experience. Optimum arm function is achieved at an early date with better cosmesis. Suitable healing and low infection rates are obtained with MIPO. Risks of iatrogenic nerve injuries are low if appropriate surgical technique is used.

Outcome of humeral shaft fractures

Humeral shaft fractures represent approximately 3% of all long-bone fractures and have historically been treated successfully in a non-operative way, but surgical management is indicated in several conditions. Although there are numerous randomized clinical trials and meta-analyses that have attempted to guide surgeons, there is little evidence and no consensus as to the most suitable treatment. Every treatment has its advantages and its complications, and many factors must be considered: not only the features of the fracture, but also patient compliance and surgeon experience.

Quick-DASH as a main early outcome of humeral shaft fractures: A Latin American multicenter prospective study.

The main objective of this study was to evaluate the Quick-Disabilities of the Arm, Shoulder and Hand Score (DASH) score as the main early (90 days) outcome in a prospective multicenter observational Latin American study on isolated humeral shaft fractures. From December 2015 to April 2017, in six Latin American countries, patients 18 years or older with a closed, isolated nonpathological 12A, 12B, or 12C AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) fractures were included. The 90 (±10)-day Quick-DASH score was used to compare the results of the different treatments. The secondary outcomes were patient treatment satisfaction, shoulder and elbow range of motion, and radiographic evaluation. A total of 92 patients successfully completed the Quick-DASH questionnaire. Surgical treatments resulted in better outcomes than nonsurgical treatment, but only minimally invasive plate osteosynthesis produced significantly lower Quick-DASH scores than nonsurgical treatment (p < 0.05). There were strong correlations between patient self-evaluation and the Quick-DASH score (p < 0.0005) but not between the Quick-DASH score and radiographic fracture healing. No significant difference was found between the treatments regarding the rate of return to work, but the medical center had a significant influence on treatment choice (p < 0.0005). The high correlation between Quick-DASH score and patient satisfaction and functional outcome indicates that the Quick-DASH questionnaire is a suitable tool for evaluating adult humeral shaft fracture outcomes. Patients with a Quick-DASH score below 15 could be considered recovered, and patients with a Quick-DASH score above 40 could be considered not yet recovered. Quick-DASH scores were not significantly associated with radiographic fracture healing.

Comparison of outcome in MIPO versus ORIF with plate Osteosynthesis in The Management of Fractures of the Shaft of Humerus

Background: Fractures of the humeral shaft are usually managed surgically with ORIF (open reduction with internal fixation) with PO (plate osteosynthesis) being the most commonly used modality of treatment. With the advent of biological fracture fixation principles, the trend currently is to go in for minimally invasive techniques. The aim of this study was to compare the functional outcomes of humeral shaft fractures treated by ORIF and MIPO (minimally invasive plate osteosynthesis) and to compare the results with studies of other authors as available in literature. Methods: 30 patients with diaphyseal fractures of the humerus who presented between Jan 2014 to Jan 2016 were randomly allocated into 2 groups with Group 1 treated by ORIF with PO (N=15) and Group 2 treated by MIPO (n=15) and were followed up for a minimum period of 2 years. Functional outcomes of both groups were assessed by the DASH score. Results: Both groups were comparable in terms of age, sex, side predominance and mode of injury.According to fracture classification, AO type A was the most common type seen followed by type B and C. The mean follow up in group 1 was 26 months ranging from 24 to 31 months while it was 27 months in group 2 ranging from 25 to 30 months. There was a significant statistical difference in group 2 pertaining to operative time, blood loss and radiation exposure with the P value < 0.001. The time to union was shorter in group 2 and the DASH score in both groups improved over the course of follow up upto a year. Conclusion: By this study we conclude that MIPO of humeral shaft fractures is a good viable and easily reproducible option in the management of these fractures and has advantages over conventional ORIF techniques in terms of reduced blood loss, shorter surgical times and earlier time to fracture union by employing biological principles of fracture fixation and gives good functional results.

Functional outcome of humeral shaft fractures in adults treated with titanium elastic nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This study was done to analyse the functional outcome of humeral shaft fractures (upper and middle third) managed with closed ante-grade intramedullary titanium elastic nailing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study of 20 patients, aged between 18 and 60 years, with humeral shaft fractures treated with titanium elastic nailing from May 2016 to April 2018 at our institute. Upper and middle humeral shaft fractures of both sexes were included in the study.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Eighteen (90%) fractures united in 12-20 weeks. Two (10%) patients had delayed union which ultimately united without any intervention. Two (10%) patients developed shoulder stiffness due to nail impingement. By evaluating ASES score, good to excellent results were noted in 18 (90%) and moderate in 2 (10%). There were 15 males and 5 females with an average age 32.75 years (range: 18-60 years).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Titanium elastic nailing is a good method for treatment of humeral shaft fractures in adults. It provides early fracture union, high union rates, minimal soft tissue damage, early rehabilitation and short hospital stay.&lt;/p&gt;

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.

Treatment Outcome of Intramedullary Fixation with a Locked Rigid Nail in Humeral Shaft Fractures.

The aim of this study was to determine the treatment outcome of humeral shaft fractures with a locked rigid intramedullary nail in patients indicated for surgical treatment. In this descriptive-cross sectional study, all patients were followed up for one, six, and 18 months post operatively. The Short Form Questionnaire (SF-36) and Constant Shoulder Score were applied. Of 78 included patients (mean age: 35), one patient had a soft tissue infection, one had secondary radial nerve palsy, eight had non-union, one had elbow limited range of motion in extension, and three patients had decreased shoulder range of motion. The Constant Shoulder Score and Short Form Questionnaire Score (SF-36) increased in all patients, although aged women showed lower improvement. Intramedullary nail fixation in the humeral shaft fracture may be associated with high rates of non-union.

Outcome of humeral shaft fractures treated by functional cast brace.

Background:Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. Instead of polyethylene bivalve functional brace four plaster sleeves wrapped and molded with little more proximal extension expected to prevent nonunion of proximal third fractures. Periodic compressibility of the cast is likely to yield a better result. This can be applied on the 1st day of the presentation as an outpatient basis. Comprehensive objective scoring system befitting for fracture humeral shaft is a need.Materials and Methods:Sixty six (male = 40, female = 26) unilateral humeral shaft fractures of mean age 34.4 years (range 11–75 years) involving 38 left and 28 right hands were included in this study during April 2008 to December 2012. Fractures involved proximal (n = 18), mid (n = 35) and distal (n = 13) of humerus. Transverse, oblique, comminuted and spiral orientations in 18, 35 and 13 patients respectively. One had segmental fracture and three had a pathological fracture with cystic bone lesion. Mechanisms of injuries as identified in this study were road traffic accidents 57.6% (n = 38), fall 37.9% (n = 25). 12.1% (n = 8) had radial nerve palsy 7.6% (n = 5) had Type I open fracture. Four plaster strips of 12 layers and 5–7.5 cm broad depending on the girth of arm were prepared. Arm was then wrapped with single layer compressed cotton. Lateral and medial strips were applied and then after molding anterior and posterior strips were applied in such a way that permits full elbow range of motion and partial abduction of the shoulder. Care was taken to prevent adherence of one strip with other except in the proximal end. Limb was then put in loose collar and cuff sling intermittently allowing active motion of the elbow ROM and pendular movement of the shoulder. Weekly tightening of the cast by fresh layers of bandage over the existing cast brace continued.Results:The results were assessed using 100 point scoring system where union allotted 30 points and 60 points allotted for angulations (10), elbow motion (10), shoulder abduction (10), shortening (5), rotation (5), absence of infection (10), absence of nerve palsy during treatment (10). Remaining 10 points were allotted for five items with two points each. They were the absence of skin sore, absence of vascular problem, absence of reflex sympathetic dystrophy (RSD), recovery of paralyzed nerve during injury and recovery of paralyzed nerve during treatment. Results were considered excellent with 90 and above, good with 80–89, fair with 70–79 and poor below 70 point. Results at 6 months were excellent in 43.94% (n = 29), good in 42.42% (n = 28), fair in 9.1% (n = 6), poor in 4.55% (n = 3). Union took place in 98.48% (n = 65) with an average of 10.3 weeks (range 6–16 weeks). 87.5% (n = 7) paralyzed radial nerve recovered. All wounds healed. Four patients had transient skin problem. One patient with mid shaft fracture had nonunion due to the muscle interposition.Conclusion:Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients.

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.

Outcome Assessment of Operative Treatment of Humeral Shaft Fractures by Antegrade Unreamed Humeral Nailing (UHN).

The purpose of this study was to assess the outcome of humeral shaft fractures treated with Unreamed Humeral Nailing (UHN) system. Fixation of the humeral shaft fractures in this study was performed by minimal incision UHN system, without using its distal locking properties. Forty one patients were treated this way. Functional status of shoulder and elbow were evaluated using Society of the American Shoulder and Elbow Surgery (SASES) scoring system. During follow up period, no superficial or deep infections were observed. Mean union time was 13weeks. Shoulder and elbow functions using SASES scale were excellent or good in 93% of the patients. Complications included delayed union in 3(7.3%), nonunion in 2(4.8%) and radial nerve palsy in 1(2.4%). Antegrade unreamed humeral Nailing is an acceptable, safe and reliable treatment for humeral shaft fractures.