Treatment Of Humeral Shaft Fractures Research Articles

Treatment of humeral shaft fractures: a new minimally-invasive plate osteosynthesis versus open reduction and internal fixation: a case control study

BackgroundTo evaluate the feasibility and safety of a new minimally-invasive surgical approach–anteromedial minimally-invasive plate osteosynthesis (MIPO)–in the treatment of middle and distal humeral shaft fractures.MethodsFourteen patients with humeral shaft fracture treated with anteromedial MIPO from November 2016 to March 2020 (MIPO Group) were selected as the study subjects. Open reduction and internal fixation (ORIF) were used to treat 14 patients with humeral shaft fractures as the control group (ORIF group). The two groups were fixed with a locking compression plate (LCP) or LCP + multi-directional locking screw system (MDLS). The incision length, intraoperative blood loss, intraoperative fluoroscopy time, operation time, length of hospital stay, fracture healing time, QuickDASH score and Constant score were observed and compared between the two groups.ResultsFourteen patients were enrolled in each group. The incision length (7.79 ± 2.39 cm), intraoperative blood loss (96.07 ± 14.96 mL), operative time (110.57 ± 21.90 min), hospital stay (6.29 ± 1.49 days) and fracture healing time (14.94 ± 0.99 weeks) in the MIPO group were all lower than those in the ORIF group, and the difference was statistically significant for each parameter (P < 0.05). The intraoperative fluoroscopy time (20.07 ± 3.22) in the MIPO group was significantly higher than that in the ORIF group (P < 0.05). There were no significant differences in age (P = 0.078), QuickDASH score (P = 0.074) or Constant score (P = 0.293) between the two groups and no postoperative complications occurred in any of the patients.ConclusionThe anteromedial approach MIPO technique has the advantages of less trauma, less bleeding, low risk of nerve injury and high rate of fracture healing. It is one of the most effective methods for the treatment of middle and middle–distal humeral shaft fractures.

Relationship between incidence of postoperative radial nerve palsy and surgical experience in the treatment of humeral shaft fractures through a posterior triceps splitting approach: A retrospective study.

The aim of this study was to investigate the incidence of postoperative radial nerve palsy (PORNP) after the surgical treatment of humeral shaft fractures through a posterior triceps splitting approach by a single surgeon's experience in a consecutive case series from a single trauma center. In this retrospective study, a total of 118 patients (82male, 36 female;mean age = 48 years, age range = 16 - 80 years)who underwent open reduction and plate fixation through posterior triceps splitting approach due to humeral shaft fractures at a level I trauma center were included. Level of the fractures was categorized as the proximal third, middle third, and distal third of the diaphysis, and then all the fractures were classified according to the AO/OTA classification system. The trend of incidence of PORNP was investigated. All the operations were performed by a single surgeon. The recovery time of PORNP was also recorded. There were 13 cases of proximal third, 67 cases of middle third, and 38 cases of distal third fracture. Based on AO/OTA classification, there were 29 cases of A1-type, 23 cases of A2-type, 42 cases of A3-type, 17 cases of B2-type, 3 cases of B3-type, and 4 cases of C2-type fracture. The overall incidence of PORNP was 11% (13 cases). All the PORNP cases fully recovered within 10.3 ± 10.4 weeks (range = 1 - 44) with conservative treatment. Incidence of PORNP significantly decreased with increase in surgical experience (P = 0.009). The incidence of radial nerve palsy was not significantly related to the level of the fracture (P = 0.199). The incidence of radial nerve palsy was not significantly related with the fracture pattern according to AO/OTA classification (P = 0.659). Evidence from this study has shown that the incidence of PORNP following the posterior triceps splitting approach for the treatment of humeral shaft fractures is significantly associated with the surgeon's experience. Level IV, Therapeutic Study.

Immediate Weight Bearing After Fixation of Humeral Shaft Fractures with Small Fragment Hybrid Plating: A Biomechanical Analysis

Background This study evaluates the stiffness of both 4.5 mm dynamic compression plates (DCP) and 3.5 mm hybrid locking-compression plates (LCP) for treatment of humeral shaft fractures in a simulated weight bearing model. Methods Testing was performed on 16 4th generation Sawbones humeri. Initial axial and torsional stiffness were determined. Plates were placed and a 5 mm defect was produced. Specimens were subjected to 90,000 loading cycles to simulate 90 days of crutch walking and then loaded to failure. Statistical analysis was performed using a t-test with significance at P &lt; 0.05. Findings Comparison reveals a significant difference between the intact axial and torsional stiffness of 4.5 mm DCPs and 3.5 mm LCPs. The 3.5 mm plates provided 80% of the axial stiffness and 75% of the torsional stiffness of the 4.5 mm plates. The 3.5 mm plated bones failed at 79% of the mean failure load of the 4.5 mm plated bones. The 3.5 mm plated bones failed due to incidental torsion during axial loading; the 4.5 mm plated bones failed as a result of gap closure. Interpretation Our results followed expectations due to differences in plate dimensions. There were no apparent differences between constructs following cyclic loading. Our model includes a fracture gap, which requires the plate to carry the entire load. This does not simulate the actual clinical scenario wherein healing would tend to improve construct performance. While the constructs performed differently, both appear to support loads that are anticipated in the clinical setting.

Functional outcome of fracture shaft humerus treated with closed antegrade intramedullary nailing in adults

Background and objectives: The treatment of humeral shaft fractures might include plate osteosynthesis or intramedullary nailing. The fracture hematoma is maintained using intramedullary nails because they are placed in a closed way, allowing for early fracture consolidation and decreased infection rates. Interlocking provides rotational stability, allowing nearby joints to mobilize more quickly. Antegrade nailing, on the other hand, has the side effect of tightening the shoulder. in this study, we wanted to see how humeral shaft fractures treated with closed Antegrade Intramedullary nailing fared in terms of time to union, functional results, and comorbidities. Methods: Twenty adult patients with acute humeral shaft fractures were treated using antegrade closed intramedullary nailing. With an average age of 38.4 yrs., there had been 17 men and 3 females (21-65 yrs.). These patients had tracked for two years as well as the outcomes were assessed. Results: 1 (5%) fracture failed to union after an average consolidation time of 13.78 weeks (11-16 weeks). There were three occurrences of intraoperative fracture comminution (15%) that had no impact on fracture healing. 2 (10%) of the patients experienced nail impingement, 1 (5%) had shoulder stiffness, and 1 (5%) had a superficial infection. Functional outcomes were good in 17 (85%), moderate in 2 (10%), and poor in 1 (5%). Results: 1 (5%) fracture failed to union after an average consolidation time of 13.78 weeks (11-16 weeks). There were three occurrences of intraoperative fracture comminution (15%) that had no impact on fracture healing. 2 (10%) of the patients experienced nail impingement, 1 (5%) had shoulder stiffness, and 1 (5%) had a superficial infection. Functional outcomes were good in 17 (85%), moderate in 2 (10%), and poor in 1 (5%).

Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures.

Surgical treatment for humeral shaft fractures has been reported to yield satisfactory results; however, there may be complications, such as delayed bone union, nonunion, iatrogenic radial nerve injury, and infection. The risk factors for postoperative complications remain largely unknown. This study aimed to investigate the influence of timing of surgery on the incidence of postoperative complications of acute humeral shaft fractures. We retrospectively reviewed 43 patients who underwent osteosynthesis for acute humeral shaft fractures between 2006 and 2020. The patients were divided into early (21 patients) and delayed (22 patients) treatment groups based on the timing of the surgical intervention (within or after four days). Outcomes were the incidences of complications (delayed union, nonunion, iatrogenic radial nerve injury, and infection) and postoperative fracture gaps. We evaluated the outcomes using plain radiographs and clinical notes. In addition, we performed subgroup analyses on outcomes in a subgroup of patients who underwent intramedullary nailing and one who underwent plate fixation. The frequency of delayed union was significantly higher in the delayed group (P=0.046), and the postoperative fracture gap size was also significantly greater in the delayed group (P=0.007). The subgroup analyses demonstrated a significant association between the increased incidence of delayed union and delayed surgical interventions only in the intramedullary nailing subgroup (P=0.017). This study suggests that performing surgery within four days after acute humeral shaft fracture is recommended to reduce the occurrence of delayed union, particularly in cases requiring intramedullary nailing fixation.

Compromising due to additive cerclages : Can surgical treatment of humeral shaft fractures cause damage to the radial nerve?

EinleitungDie Therapie der Humerusschaftfraktur ist vielfältig und oft problematisch. Neben der konservativen Therapie konkurrieren Marknagel- und Plattenosteosynthese miteinander; bislang existiert kein Goldstandard. Aus biomechanischen Überlegungen bieten sich für die Versorgung von Spiralfrakturen additive Cerclagen an. Die Argumente gegen deren Verwendung sind zum einen die Gefahr von Radialisläsionen, zum anderen eine mutmaßliche Störung der Fragmentdurchblutung. Ziel dieser Studie ist die Analyse sekundärer Radialisläsionen bei der Anwendung additiver, limitiert invasiver Cerclagen bei der antegraden Nagelosteosynthese von Humerusschaftfrakturen.MethodikIn dieser retrospektiven Studie erfolgen die klinische und die neurologische Untersuchung von 102 Patienten, welche im Zeitraum von 5 Jahren bei einer Humerusschaftfraktur operativ versorgt wurden. Insgesamt wurden zur Marknagelosteosynthese 193 Cerclagen durch einen limitiert invasiven Zugang eingebracht.Ergebnisse und SchlussfolgerungBei 4 Patienten (3,9 %) zeigte sich eine sekundäre Radialisläsion im Rahmen der operativen Stabilisierung. Die neurophysiologische und neurosonographische Untersuchung zeigten in keinem Fall eine Kompromittierung des Nerven durch Einschlingen oder gar Durchtrennung durch die additive Cerclage. Zwei Nervenläsionen erholten sich innerhalb von 3 bzw. 6 Monaten spontan. In den anderen 2 Fällen konnte der Verlauf aufgrund eines Exitus letalis nicht über 12 Monate dokumentiert werden.Mit 3,9 % der iatrogenen Radialisläsionen liegt die Rate an Nervenläsionen im unteren Bereich dessen, was in der Literatur für die operative Therapie von Humerusschaftfrakturen beschrieben wird (3–12 %). Durch die limitiert invasive, additive Cerclage ergibt sich somit kein erhöhtes Risiko für die iatrogene Schädigung des N. radialis.

MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results

IntroductionThe aim of this study was to determine the feasibility of applying the MIPO technique with a helical-shaped plate in the treatment of humeral shaft fractures with proximal extension. Patients and methodsWe present an observational prospective study of patients with a humeral shaft fracture involving the proximal humerus fixed with a long proximal humerus polyaxial locking plate with an anterior curvature and helical shape (ALPS® Zimmerbiomet, Warsaw, Indianapolis, USA), using a MIPO technique. Between January 2017 and July 2020, 15 patients were treated at our institution. Proximally a 4–5 cm anterolateral transdeltoid approach was made. And distally, a 5–7 cm incision was made 4 cm proximal to the elbow crease. At each follow-up, radiographs were taken to evaluate fracture healing. Funtional scales were applied to evaluate clinical results. ResultsTen women and five men were included, with a mean age of 62 yo (range 26–86). All but one fracture healed uneventfully. The mean time to union was 28 weeks (range 12–48 weeks). Two out of 15 patients presented complications (an atrophic nonunion and a peri‑implant distal fracture). None of the patients had a nerve palsy prior neither after the surgery. No other complications, including infection, were registered during follow-up. Shoulder range of motion showed the following means: abduction of 147° (range 50°-180°), anterior flexion of 144° (range 80°-180°), external rotation of 77,5 ° (range 70°-80°) and internal rotation of 54.5° (range 45°-60°). All patients recovered their pre-fracture elbow range of motion. All patients presented less than 10° of angular deviation in varus/valgus or ante/recurvatum after the surgical procedure. At the end of the follow-up, all final functional scores were “good” or “excellent”: mean Constant-Murley score was 72 ± 13 (range 38–91), ASES score was 73 ± 12 (range 41–88), UCLA shoulder scale was 30 ± 3,5 (range 10–35), and Q-DASH score was 16.5 ± 0,11 (range 4–57). ConclusionWhen applied correctly, the treatment of diaphyseal humeral fractures involving the proximal humerus using a polyaxial locking helical plate with a MIPO technique is a reliable treatment method. It has high union rates with low complications.

Distally Cemented Modified Hackethal’s Technique in the Management of Humeral Shaft Fractures, Surgical Technique, and Preliminary Results

Introduction: In 1961, Hackethal has introduced the use of multiple stacked flexible intramedullary (IM) rods in the treatment of humeral shaft fractures which is a minimally invasive method, that allowed optimal reduction with the use of IM fixation, opting for biological healing. However, this technique has several limitations that include little control over rotational stability, shortening, pin migration, and irritation of the triceps. Materials and Methods: In this paper, we present our modification of the classic Hackethal’s surgical technique by adding cement distally, thus making it a locked IM construct. Results: Preliminary results in 8 patients who underwent modified Hackethal’s technique are presented in this paper. This technique shows promising preliminary results at the level of healing, range of motion, rate of complications, cost reduction, and ease of removal of the material. Discussion: This modification allows better and more control in terms of rotation and shortening, especially in comminuted fractures. It also eliminates the risk of pin migration and triceps irritation, with ability to mobilize the shoulder and elbow immediately postoperatively (postop) compared with prolonged immobilization by the classic technique. These factors lead to a better postop function of the elbow and shoulder in addition to a faster recovery and return to activity. To note, the cost of this procedure is very low compared with plate fixation and other IM techniques. This surgical technique is used in patients who are not candidates for conservative treatment, and whose health care plan does not financially cover the cost of plate osteosynthesis or intramedullary nailing. This modified technique is highly cost-efficient, and it emerges as a viable treatment option in selected cases in third world countries, where the luxury of using expensive orthopedic implants is not accessible for many patients.

Minimally Invasive Plate Osteosynthesis versus Intramedullary Nailing for Fixation of Humeral Shaft Fractures in Adults

Introduction: The two methods of treatment of humeral shaft fractures, namely minimally invasive plate osteosynthesis (MIPO), and antegrade intramedullary nailing (IMN) are reported as satisfactory procedures. Objective: To compare the clinical and radiological results of MIPO and IMN techniques in surgical treatment of mid humeral shaft fractures. Patients and methods: From March 2017 to July 2018, a prospective study on 60 patients with closed unilateral mid- humeral shaft fractures were surgically treated with MIPO or IMN. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes (clinically and radiologically) were recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. Complications in both groups have been reported. The follow-up duration ranged from 6 to 12 months with a mean duration of 6.7 months. Results: For group 1 having MIPO technique, the average operative time was 90.3 min (range 50–110), while mean blood loss was 167 ml (range 120–200). In group II patients (interlocking humeral nail), the average time of operation was 100.1 min (range 65–120), and mean blood loss was 118 ml (range 90–150). The mean Constant-Murley shoulder score was 86.95±15.7 in MIPO group and 88.75±13.7in IMN group. The mean Mayo Elbow Performance score in MIPO and IMN groups was 96.5 ± 5.87 and 95.8 ± 6.77, respectively. Radiologic bony union was achieved in 29 out of 30 patients in MIPO group and in 28 out of 30 in IMN group. All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in both groups. Shoulder impingement was found in 2 patients in IMN group. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.

Management of Humeral Shaft Fracture by Antegrade Interlocking Intramedullary Nail

<i>Background</i>: The humeral shaft fracture is relatively common fracture among the younger and older age groups of people followed by direct or indirect violence. Humeral shaft fractures account for approximately 3% of all fractures. We have very few data regarding issue. <i>Aim of the study</i>: The aim of this study was to collect information regarding the procedure and outcomes of antegrade interlocking intramedullary nail in treating humeral shaft fracture. <i>Material and methods</i>: This study was carried out during the period from January 2017 to January 2020 at TMSS Medical College and RCH Bogura & Natore Trauma Center and Hospital, Natore, Bangladesh. Total 15 patients were selected where 10 were male and 5 were female. The study was approved by the ethical committees of mentioned both the institution. Proper written consents were taken from all the participants before starting the main intervention. All data were collected analyzed and disseminated by MS Office program. <i>Results</i>: Postoperative infection were found in 2 patients (13.33%) and shoulder pain in 1 case (6.67%). In this study, excellent and good result were accepted as Satisfactory while fair and poor results were regarded as being unsatisfactory. Among them 5 (33.33%) cases were excellent, 7 (46.67%) cases good, 2 (13.33%) cases fair and 1 (6.66%) cases poor. In this study, overall satisfactory result was found in 12 (80%) cases and unsatisfactory in 3 (20%) cases. <i>Conclusion</i>: The antegraded interlocking intramedullary nail is an effective and technically demanding method for the treatment of humeral shaft fracture.

ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies.

There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with open reduction internal fixation (ORIF) for humeral shaft fractures regarding non-union, re-intervention, radial nerve palsy, time to union, operation duration and functional outcomes. PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing MIPO with ORIF for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies). A total of two RCT's (98 patients) and seven observational studies (263 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. MIPO carries a lower risk for non-union (RD: 5%; OR 0.3, 95% CI 0.1-0.9) and secondary radial nerve palsy (RD 5%; OR 0.3, 95%CI 0.1- 0.9). Nerve function eventually restored spontaneously in all patients in both groups. Results were inconclusive regarding re-intervention (RD 7%; OR: 0.7, 95%CI 0.2-1.9), infection (RD 4%; OR 0.4, 95%CI 0.1-1.5), time to union (MD -1 week, 95%CI -3 - 1) and operation duration (MD -13 minutes, 95%CI -38.9 - 11.9). Functional shoulder scores (SMD 0.01, 95%CI -0.3 - 0.3) and elbow scores (SMD 0.01, 95%CI -0.3 - 0.3) were similar for the different operative techniques. MIPO has a lower risk for non-union than ORIF for the treatment of humeral shaft fractures. Radial nerve palsy secondary to operation is a temporary issue resolving in all patients in both treatment groups. Although both treatment options are viable, the general balance leans towards MIPO having more favorable outcomes.

Can the complications of distal locking be prevented with a new nail that offers a novel locking technique in the treatment of humeral shaft fractures?

Objectives This study aims to investigate whether complications related to distal locking can be prevented with InSafeLOCK® nail in the treatment of humeral shaft fractures.Patients and methods Hospital records of 31 patients (15 males, 16 females; mean age 54.4±10.1 years; range, 20 to 86 years) treated with InSafeLOCK® nail for humeral shaft fractures were investigated retrospectively between February 2016 and January 2019. AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification was used to determine the type of fracture. During the implementation, the elapsed time for distal locking was investigated. Complications encountered during both implementation and postoperative follow-up were investigated.Results Fourteen of the fractures were type A, 12 were type B, and five were type C. The mean follow-up time was 18.2 (range, 6 to 30.5) months. The mean duration for distal locking was 2.1 (range, 1.2 to 3.1) minutes. In one (3.2%) patient, cortical penetration occurred at the anterior cortex of the humerus at distal to the nail. In one patient, nail breakage occurred at the distal part of the nail. In one patient, rotational instability occurred due to screw loosening.ConclusionInSafeLOCK® humeral nail is safe when applied with the recommended technique. It can easily be applied without damaging the veins, nerves or other soft tissues around the elbow due to the internal distal locking feature; furthermore, there is no need to use fluoroscopy or targeting guide. Thus, it is possible to avoid complications that may occur during and after distal locking in conventional intramedullary nail implementations.

Humeral shaft fractures: how effective really is functional bracing?

The aim of this study was to assess the effectiveness of functional bracing in the treatment of humeral shaft fractures and identify factors that increased the risk of delayed or non-union. All patients with humeral shaft fractures treated at Musgrove Park Hospital between 2010 and 2017 were identified. Patient electronic records were reviewed to identify demographic data, as well as outcomes and complications following treatment. Radiographs were reviewed to identify fracture pattern and location as well as fracture displacement and angulation. In total, 65 patients were treated with functional bracing of which 22 patients (34%) had a delayed or non-union. Fracture displacement and angulation were significantly associated with delayed or non-union. In particular, patients with fractures displaced more than 30 mm or angulated more than 30° had a significantly higher risk of delayed or non-union. Fracture location or pattern was not significantly associated with delayed or non-union. Functional bracing is an effective treatment modality for the majority of patients with humeral shaft fractures, but patients with markedly displaced or angulated fractures are at a higher risk of failure of conservative treatment and therefore early operative intervention should be considered.

Declining Orthopaedic Shoulder and Elbow Surgery Medicare Reimbursement Rates from 2000 to 2019

Objectives:In the field of orthopaedics, it has been evident that Medicare reimbursement rates have been relatively stagnant. Although, objective measures of how these financial trends have changed over the past couple of decades has been limited. If orthopaedic practitioners and hospital administrators wish to make progress and advance the degree of satisfactory reimbursement they can expect, a more thorough understanding of these trends is warranted. In this study, the field of orthopaedic shoulder, elbow, and upper arm surgery is being analyzed specifically. The objective of this analysis was to assess the monetary trends in Medicare reimbursement rates for the 10 most commonly utilized shoulder surgical procedures and the 10 most commonly utilized elbow and upper arm surgical procedures from 2000 to 2019.Methods:For this analysis, the current procedural terminology (CPT) code ranges that corresponded to “Surgical Procedures of the Shoulder” and “Surgical Procedures of the Humerus (Upper Arm) and Elbow” were determined. The Medicare Provider Utilization and Payment Data: Physician and Other Suppliers PUF CY 2017 document was then utilized to objectively determine the 10 most common CPT codes fororthopaedic shoulder surgical procedures and orthopaedic elbow and upper arm surgical procedures. The reimbursement data for each of these procedures was then compiled from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services. All monetary data points were adjusted for inflation to 2019 US dollars utilizing changes to the United States consumer price index. The average annual and the total percentage change in reimbursement were based on the adjusted trends for the 10 included shoulder procedures and the 10 included elbow and upper arm procedures.Results:After adjustment for inflation, the average reimbursement for the top 10 orthopaedic shoulder surgery procedures decreased by 25.8% from 2000 to 2019. The greatest mean decrease was observed in the “Repair of ruptured musculotendinous cuff (e.g. rotator cuff) open; chronic (23412)” CPT code (-40.1%). No adjusted reimbursement rates were noted to be positive throughout the study period for surgical shoulder procedures. The procedure with the smallest mean decrease was the “Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation (23600)” CPT code (-5.4%). From 2000 to 2019, the adjusted reimbursement rate for all included shoulder procedures decreased by an average of 1.6% per year. For the top 10 orthopaedic elbow and upper arm surgical procedures, the average reimbursement decreased by 19.5% from 2000 to 2019. The greatest mean decrease was observed in the “Osteoplasty,humerus (e.g., shortening or lengthening) (24420)” CPT code (-32.1%). The procedure with the only positive mean difference was “Closed treatment of humeral shaft fracture; without manipulation (24500)” CPT code (0.34%). From 2000 to 2019, the adjusted reimbursement rate for all included elbow and upper arm procedures decreased by an average of 1.2% per year.Conclusion: To our knowledge, this is the first study to evaluate the orthopaedic shoulder and elbow subspecialtyand its trends in Medicare reimbursement rates. When monetary data is corrected for inflation, Medicare reimbursement rates have shown a steady decline from 2000 to 2019. The 10 most common procedures of or relating to the shoulder have decreased by an average of 25.8% while the 10 most common procedures of or relating to the elbow or upper arm have decreased by an average of 19.5%. Additionally, only one procedure showed a positive increase in reimbursement rate (Closed treatment of humeral shaft fracture; without manipulation (24500)). If access to high quality and sustainable surgicalorthopaedic care is to persist in the United States, increased awareness of these trends is important for stakeholders to take note of.

Surgical Treatment of Humeral Shaft Fractures by Arthroscopyassisted Intramedullary Nail Fixation

Surgical Treatment of Humeral Shaft Fractures by Arthroscopyassisted Intramedullary Nail Fixation

What should be the timing of surgical treatment of humeral shaft fractures?

This study aims to evaluate the timing of surgery in surgically treated humeral shaft fractures, to investigate the effects of surgical time on fracture recovery and complications.This was a retrospective and observational study, based on patient data who underwent surgical treatment of humeral shaft fractures from January 2012 to January 2019. There were 52 patients (19 were women and 33 men) with traumatic humeral shaft fractures who were treated consecutively at our hospital.There was a statistically significant difference in time to start physical therapy, time between surgery and bone union, and time between bone fracture and bone union. The mean time to start physical therapy in group 1 was 6.5 weeks (range, 5–12 weeks), it was 10 weeks (range, 6–14 weeks) in group 2 (P < .001). The mean time between surgery and bone union in group 1 was 14.58 weeks (range, 12–20 weeks), it was 17.4 weeks (range, 8–30 weeks) in group 2 (P: .009). The mean time between bone fracture and bone union in group 1 was 113.2 days (range, 86–114 days), it was 179.2 days (range, 89–355 days) in group 2 (P < .001).Classically the first treatment option for humerus shaft fractures is conservative if there is no absolute surgical indication. Surgical treatment may be the first option if patients want to return to early everyday life. Delayed surgery means delayed physical therapy and this means delayed recovery and return to everyday life. In today's technology world, it should be discussed that the initial treatment of uncomplicated humerus shaft fractures is a conservative treatment.

A hospital based prospective study to assess the functional outcome of nailing versus plating in fracture shaft of humerus

Introduction: The treatment of humeral shaft fractures using intramedullary nailing (IMN) and dynamic compression plating (DCP) is controversial. The present study was designed to evaluate the functional outcome, fracture union time and complications of IMN and DCP for fractures of humerus shaft. Methods: This hospital based one year prospective study was done in the Department of Orthopaedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2014 to December 2014. A total of 30 patients with humeral shaft fractures were studied. Based on the method of treatment, patients were divided into two groups of 15 each as group A (Nailing) and group (Plating). Patients were followed up for the fracture union, complications and functional outcome based on Constant Murley score. Results: Majority of the patients (80%) in group A were males while in group B, 53.33% of the patients were males. (p=0.121). The mean age was comparable in both the groups (34.33±11.27 vs. 33.20±11.73 years; p=0.789). There was almost equal distribution of patients in group A and B with respect to fracture side, type, mode of injury and associated injuries (p>0.050). In group A, shoulder stiffness and superficial infection were present in 13.33% and 6.67% of the patients while in group B, radial nerve palsy and superficial infection were noted in 6.67% and 13.33% of the patients respectively. Conclusion and Interpretation: Intramedullary nailing and DCP are equally effective for the treatment of shaft of humerus fractures.

Modern Results of Functional Bracing of Humeral Shaft Fractures: A Multicenter Retrospective Analysis

To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention. Multicenter, retrospective analysis. Nine Level 1 trauma centers across the United States. A total of 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 to 2015 were reviewed retrospectively from 9 institutions. Functional brace. Conversion to surgery. A total of 344 fractures (29%) ultimately underwent surgical intervention. Reasons for conversion included nonunion (60%), malalignment beyond acceptable parameters (24%), inability to tolerate functional bracing (12%), and persistent signs of radial nerve palsy requiring exploration (3.7%). Univariate comparisons showed that females and whites were significantly (P < 0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P < 0.05). Proximal shaft as well as comminuted, segmental, and butterfly fractures were also linked to a higher rate of conversion. This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Humeral shaft fractures treated by closed retrograde intramedullary kirschner wire fixation

Context: Flexible intramedullary nails have been reported to provide a stable humeral fixation with satisfactory results in terms of union and complications. In this study, Kirschner wire (K-wire) was used to achieve a closed intramedullary fixation of humeral shaft fractures. Subjects and Methods: This study included forty cases of the displaced diaphyseal fracture of the humerus based on inclusion and exclusion criteria. The study was done at Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, between the periods January 2003 and November 2006. All the cases were operated after clinical evaluation. The final evaluation of the result was done by Qidwai's clinical and radiological criteria. Results: A total of forty cases were available for the study. K-wire of different sizes was used; the average duration of surgery was 45.3 ± 7.2 min. The average time taken for radiological union was 12.1 ± 1.9 weeks. The patients were analyzed by Qidwai's criteria and had excellent result in 30 (83.3%) cases, good in 4 (11.1%) cases, and poor in 2 (5.6%) cases. Three patients were lost to follow-up, and one patient was died due to medical illness. Conclusion: Intramedullary K-wire fixation is a satisfactory, safe, simple, minimally invasive technique and cost-effective treatment for humeral shaft fractures. It gives elastic mobility and stability.

Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

BackgroundFractures of the humeral shaft represent 2–4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications.MethodsWe conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery.ResultsBetween 2006 and 2014, 58 patients (mean age, 59.9; range, 19–97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented.ConclusionsOpen reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.