Treatment Of Humeral Fractures Research Articles

Trend shift in proximal humeral fracture treatment: a detailed review of national shoulder arthroplasty data.

This study aimed to scrutinize nationwide utilization trends of shoulder arthroplasty for proximal humerus fractures (PHFs) using a comprehensive national surgical database. A retrospective study was conducted with 4181 patients who underwent shoulder arthroplasty due to PHF between 2016 and 2022 using national health records. They are grouped as hemiarthroplasty (HA), anatomical total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). The patients' demographic data, length of hospital stay, revision histories, transfusion rates, mortality data, trends in arthroplasty methods over the years, the distribution of cases by hospital characteristics and geographical regions were analyzed. Treatment with HA was administered to 22.1% of patients, TSA to 30.2%, and RSA to 47.7%. The lowest revision rate was observed after HA (4.3%), while higher rates were recorded after TSA (7.9%) and RSA (7.4%) (p = 0.019). It was observed that there was a significant increasing trend in RSA rates and a decreasing trend in HA and TSA rates over time (p < 0.001). From 2016 to 2022, there appears to have been a significant increase in the utilization of RSA for the arthroplasty treatment of proximal humeral fractures in Türkiye, and it is used more frequently than HA. However, revision rates after RSA are still higher than those after HA. Level III, retrospective cohort study.

Comparison of Short Uncemented Metaphyseal Stem and Long-Stem Reverse Shoulder Arthroplasty in Proximal Humerus Fractures: Preliminary Study at 2-Year Follow-Up.

Introduction: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for possible future revision surgery. The main objective of our study was to validate the use of a short stem prosthesis in the surgical treatment of humeral fractures by comparing clinical and radiological outcomes of our studied implant with those obtained with the use of traditional long-stem implants. Methods: In this multicentric, controlled prospective study, 125 patients with proximal three- or four-fragment humerus fractures were selected and treated with RSA. A short stem was used in group A (n = 53, mean age: 75.6 ± 5.6 years old), and a long stem was used in group B (n = 72, mean age: 71.76 ± 3). Active range of motion (ROM), Constant score (CS), Quick DASH, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Visual Analog Scale (VAS) scores were collected and analyzed at 2 years mean follow-up, as well as humeral and glenoid bone resorption (sum Inoue scores and Sirveaux scores were used). Results: No statistically significant differences were observed between group A and B in ROM, Constant score (51.69 ± 15.8 vs. 53.46 ± 15.96, p > 0.05), Quick DASH (31.5 ± 21.81 vs. 28.79 ± 13.72, p = 0.85), ASES (82.53 ± 17.79 vs. 84.34 ± 15.24, p = 0.57), or the VAS (0.53 ± 1 vs. 0.56 ± 1.07, p = 0.14) at the final follow-up. No statistically significant differences were found in the radiographic parameters between the two groups. No statistically significant differences were found for the average degree of humeral and glenoid bone resorption either. Conclusions: The use of a short metaphyseal-socket stem can be considered a safe, effective, and feasible option in reverse shoulder arthroplasty for treating proximal humerus fractures. Our results are encouraging, with no statistically significant differences identified between the proposed treatment and traditional long stems.

Biomechanical analysis of push-pull principle versus traditional approach in locking plates for proximal humeral fracture treatment.

Proximal humerus fractures are usually treated with locking plates, which could present recurrence, screw penetration, joint varization. The push-pull principle was introduced to prevent these risks and showed promising results; a dedicated design was then developed and this feasibility study aims to compare the biomechanical performances of such dedicated push-pull plate with the traditional locking plate using finite elements. The humerus geometry was obtained from Sawbone CT-scans; the geometries of a traditional locking plate and of the dedicated push-pull one were used. A fracture was added below the humeral head and the plates were virtually implanted. The wire pulling mechanism was simulated connecting the plate to the humeral head apex, considering two levels of tension. Three testing set-ups (axial, torsion and compression bending) were simulated. Stress distributions on bone, plate and screws were measured. Stress distribution on the distal humerus was similar for both plates. Stress distribution on the proximal humerus was more homogeneous for the push-pull model, showing less unloaded sections (up to 78%). The different levels of tension applied to the wire returned slight differences in terms of stress values, but the comparison with the traditional approach gave similar outcomes. More homogeneous stress distribution is found with the push-pull plate in all three testing set-ups, showing lower unloaded areas (and thus lower stress-shielding) compared to the traditional plate; the screws implemented returned to be all loaded in at least one of the set-ups, thus showing that they all contribute to plate stability.

Fracture Healing in 37 Dogs and Cats with Implant Failure after Surgery (2013-2018).

Implant failure is common in small animal orthopedics, but risk factors are rarely reported. Our objective was to determine whether abnormal fracture healing was associated with implant failure after fracture fixation in dogs and cats in a consecutive series of cases. Thirty-seven client-owned animals (thirty-two dogs, five cats) diagnosed with implant failure after fracture treatment from January 2013-September 2018 were studied. Medical and radiographic records were retrospectively reviewed to identify patients that underwent fracture fixation using open reduction and internal fixation with subsequent radiographic evidence of implant failure. Area moment of inertia (AMI), plate working length, and bone screw density were determined. Implant failure was found in 39 fractures in 37 animals, representing 23% of fracture cases during the study period. Cases of implant failure were at increased risk of delayed union, malunion, or non-union (p < 0.0001). The most common cause of implant failure was loosening (54%); the second most common was plate failure that included low AMI locking plates (28%). Major complications found in 22/39 fractures (56%) were associated with delayed union (p < 0.01). Surgical revision was performed in 49% of implant failure cases. Complications were most frequently identified after treatment of humeral fractures (26%). We conclude mechanical failure of implants increases the risk for delayed or abnormal fracture healing and often requires revision surgery. Implant AMI should be considered during preoperative planning. Locking plates are associated with implant failure if plate bending stiffness is not sufficient, based on findings from this case series.

Shoulder arthroplasty for proximal humeral fracture treatment: a retrospective functional outcome analysis.

Following proximal humeral fractures hemiarthroplasty (HA) or reversed total shoulder arthroplasty (rTSA) are performed if osteosynthesis or conservative treatment is not possible. HA has been reported to result in decreased functional outcomes compared with rTSA. Secondary shoulder arthroplasty, performed after a different initial treatment, has also been associated with inferior outcomes. Patients recieving a shoulder arthroplasty related to a proximal humeral fracture from 2010 to 2019 were included. A retrospective analysis of functional outcomes was performed using QuickDASH and subjective shoulder value (SSV). The mean [standard deviation (SD)] follow-up time among the 82 included patients was 48 (28) months. The mean age was 70 (10) years. The mean age for HA was significantly different from rTSA [57 (9) and 72 (21) years; p < .001]. The mean QuickDASH score for primary arthroplasty was 11 (2) versus 12 (16) for secondary arthroplasty (p = .313). The mean SSV for primary arthroplasty was 84 (22) versus 82 (17) for secondary arthroplasty (p = .578). The mean QuickDASH score for HA was 24 (36) versus 9 (15) for rTSA (p = .346). The mean SSV for HA was 70 (34) versus 86 (17) for rTSA (p = .578). Functional outcomes after fracture-related shoulder arthroplasty were excellent in an older population, even when performed secondarily after failed primary osteosynthesis or conservative treatment. No significant differences in shoulder function were identified between rTSA and HA, likely due to restrictive indications for HA.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

DOES CEMENT CURING CAUSE CONCERNING INCREASE OF THE TEMPERATURE WHEN DELIVERED IN THE HUMAN HUMERUS?

For the treatment of humeral fractures, numerous strategies exist to improve the clinical outcome of the reconstruction and to reduce the incidence of fixation failure. Injection of acrylic-based cements to reinforce the bone and/or augment the screws is one option. The heat generated during cement polymerization raises some concerns, as it could cause tissue damage. The first aim of this study was to measure the temperature over time during polymerization when acrylic cements are delivered inside the bone to treat fracture. The second aim was to assess if the ISO-5833:2002 standard can predict what happens in a real bone. Different tests were performed using two acrylic-based cements (Mendec and Cal-Cemex): (i) the ISO-5833:2002 standard (Annex C); (ii) tests on human bones (humeral diaphysis and humeral head) injected with cement to simulate fracture treatment. In the humeri, the highest temperature was measured in the diaphysis (68.6∘C for Mendec, 62.7∘C for Cal-Cemex). These values are comparable with the temperature reached in other consolidated applications (vertebroplasty). Exposure to high temperature was shorter for the diaphysis than for the head. For both cements, in both the diaphysis and the head, temperatures exceeded 48∘C for less than 10[Formula: see text]min. This is within the threshold for tissue necrosis. The ISO-5833:2002 yielded significantly different results in terms of maximum temperature (difference exceeding 15∘C) and exposure to temperature above 48∘C and 45∘C. This discrepancy is probably due to a combination of factors affecting the amount of heat produced and dissipated (e.g., amount and shape of the cement, thermal conductivity).

Treatment of humeral fractures with long PHILOS plates using a modified technique and approach avoids radial nerve palsy in the last 10 years

Abstract Objective Radialis paresis is a known complication of plate osteosynthesis of the proximal humeral shaft. There are major differences with regard to surgical approach and implant. The standard treatment is a lateral-lateral approach. Here, iatrogenic damage to the radial nerve is a relevant complication. In our institution, these fractures have been treated with an adapted procedure for about 10 years. A long Philos plate is inserted proximally via a deltoido-pectoral approach. The plate is first torqued distally by about 45°-90° and then lies anteriorly on the humerus. The distal screws can be placed via anterior stab incisions. The advantage of this technique is that the implant and approach respect the anatomical course of the radial nerve and it does not have to be manipulated in an open exploratory manner. The aim of the study is to demonstrate the effectiveness of the surgical technique in relation to iatrogenic radial nerve paresis in comparison to the literature. Methods We analysed patients with a proximal humeral shaft fracture who were treated at our clinic with a long torqued philos plate using the adapted surgical method over the last 10 years. The fracture, the occurrence of iatrogenic radial damage and biometric data of the patients were analysed retrospectively. Results We found a total of 59 patients who underwent surgery according to the above-mentioned scheme between 2010 and 2020. The average age was 70.1 (40-101) years. There were 44 women and 15 men. 2 patients had a preoperatively documented radial nerve damage. In 57 patients, no damage could be found in the radialis supply area both pre- and postoperatively. 2 patients died shortly after surgery, 6 patients were loss to follow up. 2 patients had a tear of the distal plate bearing (1 malcompliance/1 pseudarthrosis). Both had to be revised. In the remaining 47 patients (78%), the healing process was unremarkable. Conclusion The described treatment of the proximal humeral shaft fracture has been successfully practised at our clinic for 10 years. Most of the fractures healed without complications. Compared to the exploration of the nerve, this method respects the anatomical course of the nerve and shows in the retrospective analysis that no iatrogenic damage to the radial nerve occurred. Thus, the surgical method represents a valid alternative to the established implants and classical surgical treatments.

Clinical effects between cannulated screw and bone plate internal fixation for humeral tuberosity fracture:a Meta analysis

To compare clinical effect of cannulated screw and bone plate for the treatment of humeral fracture of greater tuberosity. From January 2010 to January 2020, clinical trial literatures on the treatment of humeral tuberosity fractures with cannulated screw and bone plate were searched by PubMed, EMbase, Cochrane Library, Wanfang, CNKI, CBM Database, VIP Database and other databases. Independent literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Revman5.2 software was used to perform Meta analysis. Totally 5 clinical randomized controlled trials and 12 cohort studies were selected, including 1 068 patientsin which 559 patients were treated by cannulated screw internal fixation and 509 patients treated by bone plate internal fixation. Meta analysis resluts showed that there were satistical differences in operation time[MD=-23.03, 95% CI(-29.69, -16.36), P<0.000 1], blood loss[MD=-36.39, 95% CI(-53.73, -19.04), P<0.000 1], hospital stay[MD=-1.86, 95%CI(-3.09, -0.64), P=0.003], fracture healing time [MD=-2.23, 95% CI (-4.27, -0.18), P=0.03], postoperative incidence of infection [OR=0.17, 95%CI (0.03, 0.97), P=0.05], failure rate of internal fixation [OR=3.56, 95% CI (1.29, 9.81), P=0.01] bwteen two groups. While there were no differences in postoperative visual analogue scale (VAS)[MD=-1.34, 95% CI (-2.77, 0.09), P=0.07], American Shoulder and Elbow Surgeons(ASES)[MD=0.26, 95% CI(-6.43, 6.96), P=0.94], Constant shoulder score [MD=-4.05, 95% CI(-8.51, 0.42), P=0.08], excellent rate of Constant shoulder score[MD=-1.30, 95% CI(0.46, 3.72), P=0.62], excellent rate of Neer shoulder joint score[OR=2.04, 95% CI(0.97, 4.28), P=0.06], total complication rate[OR=1.50, 95% CI (0.42, 5.35), P=0.53], incidence of postoperative pain[OR=0.74, 95% CI(0.04, 14.49), P=0.84] and incidence of postoperative acromion syndrome [OR=0.88, 95% CI (0.02, 40.63), P=0.95] between two groups. Compared with bone plate, cannulated screw for the treatment of humeral fracture of greater tuberosity has advantages of shorter opertaion time, less blood loss, shorter hospital stay, lower incidence rate of postopertaive infection, and more benefit for fracture healing.

Comparison of Open Reduction and Internal Fixation with Plate and Titanium Elastic Intramedullary Nail in Treating Pediatric Humeral Fracture

ObjectiveTo investigate the therapeutic efficacy of titanium elastic intramedullary nail (TEN) and open reduction and internal fixation with plate (ORIF) in the treatment of humeral fracture in children.MethodsA retrospective study was carried out in a total of 69 patients who were admitted to the hospital from January 2013 to December 2018. These patients, including 41 males and 28 females, were aged from 6 to 12 years old with a median of 8 years. These patients were diagnosed with humeral fracture and underwent the surgery of ORIF (n = 22) or TEN (n = 47). The intraoperative bleeding, operation time, length of stay (LOS), and fracture healing time were compared between the two groups. The therapeutic effect was assessed by the shoulder range of motion, the elbow range of motion, the UCLA shoulder function score, and the Mayo elbow performance score (MEPS) 6 months after the surgery.ResultsThe intraoperative bleeding (97.20 ± 27.83 mL vs 185.60 ± 37.50 mL, P < 0.05), the operation time (53.70 ± 11.87 min vs 73.50 ± 13.33 min, P < 0.05), and the fracture healing time (9.30 ± 4.23 weeks vs 13.45 ± 3.67 weeks, P < 0.05) in the TEN group was significantly decreased than those in the ORIF group. There was no significant difference in the LOS between the two groups. The length of follow‐up is 3 and 6 months. The shoulder range of motion (110.88° ± 15.82° vs 98.37° ± 16.22° at 3 months and 162.88° ± 17.29° vs 117.65° ± 19.38° at 6 months, both P < 0.05), the elbow range of motion (105.23° ± 2.81° vs 87.12° ± 4.73° at 3 months and 137.47° ± 4.82° vs 109.67° ± 5.83° at 6 months, both P < 0.05), and the UCLA shoulder function score (28.58 ± 4.74 vs 21.64 ± 7.23 at 3 months and 33.05 ± 3.27 vs 25.78 ± 3.87 at 6 months, both P < 0.05), and the MEPS (80.76 ± 3.53 vs 65.33 ± 9.43 at 3 months and 97.48 ± 1.23 vs 88.22 ± 3.65 at 6 months, both P < 0.05) in the TEN group were greater than those in the ORIF group. In the TEN group, complications occurred in three of 47 cases (6.38%), including one case (2.13%) of bone nonunion and two cases (4.25%) of irritation response around the nail. In the ORIF group, complications occurred in four of 22 cases (18.18%), including one case (4.55%) of delayed healing, one case (4.55%) of deep infection, and two cases (9.08%) of radial nerve injury. The complication rate was not significantly different between the two groups.ConclusionTEN can be a good technique for the treatment of humeral fracture in children, with the advantages of less intraoperative bleeding, shorter operative time, quicker healing, and better recovery of shoulder range of motion and elbow range of motion.

Operative Treatment of Proximal Humeral Fracture-dislocations Through an Anterolateral Deltoid Split Approach.

Proximal humeral fracture-dislocations (PHFD) are a special entity in proximal humeral fracture treatment. The aim of this study is to present our minimally invasive plate osteosynthesis (MIPO) technique through an anterolateral deltoid split approach. In addition, we performed a retrospective cohort study analyzing the patient reported functional outcome and complications. A single center cohort study was performed. All patients operated through a deltoid split approach for PHFD between 2009 and 2016 were eligible for inclusion. The primary endpoint was subjective shoulder function measured with QuickDASH and subjective shoulder value (SSV). Secondary endpoints were complications and implant-related irritation. 28 patients were included. The mean age was 49 (SD ± 10.3). The mean follow-up was 48 months (SD ± 23.7). The mean QuickDASH score was 6.8 (SD ±7.8) and the mean SSV was 86 (SD ±14.6). Four patients had a conversion into a reversed arthroplasty (14%), one patient (4%) a shortening of secondary perforated screws, four patients an early re-osteosynthesis (14%), four patients (14%) developed an AVN and in one patient damage of the axillary nerve was observed. 21 patients (75%) had their implant removed. Patient reported functional results after humeral head preservation and internal fixation of PHFDs through an anterolateral deltoid spilt approach are promising. However, there is a high rate of re-operations either because of complications or for implant removal. Comparing our data to literature these rates are not depending on the approach chosen.

Advantages of percutaneous minimally invasive plate internal fixation in the treatment of complex proximal humeral fractures

Objective To explore the clinical advantages of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of proximal humerus fractures of Neer typeⅢ andⅣ. Methods From May 2015 to May 2018, 78 cases of proximal humerus fractures of Neer type Ⅲ and Ⅳ were treated with MIPPO and open reduction and internal fixation (ORIF). There were 36 cases in MIPPO group, 20 males and 16 females, including 21 cases of Part Ⅲ fractures and 15 cases of Part Ⅳ fractures; and 42 cases in ORIF group, 24 males and 18 females, including 26 cases of Part Ⅲ fractures and 16 cases of Part Ⅳ fractures. The length of incision, the amount of bleeding, the time of operation, the time of fracture healing, the UCLA score of shoulder joint before and 3, 6 months after operation, the Constant-Murley score of shoulder joint function at 3, 6, 12 months after operation, the classification of joint function at the last follow-up, the axillary nerve injury and other complications were compared. The shoulder joint function of MIPPO group was evaluated after fracture healing. Results All the 78 patients were follow-up for (17.3±2.8) months. The incision length, fracture healing time and intraoperative bleeding in MIPPO group were significantly shorter than those in ORIF group. The UCLA scores of shoulder joint in MIPPO group were 29.04±1.63 and 30.95±1.69 at 3 and 6 months after operation, which were higher than those in ORIF group 22.11±2.33 and 25.96±2.01. The shoulder function Constant-Murley scores of MIPPO group were 55.64±2.83 and 75.01±5.71 at 3 and 6 months after operation, which were higher than those of ORIF group 45.03±6.32 and 64.61±6.77. However, there was no significant difference between the two groups in the shoulder function Constant-Murley score and the last shoulder function grade at 12 months after operation. After fracture healing, the shoulder function of MIPPO group was further evaluated: the average flexion angle was 170.5 ° (ranged, 161° to 180°), the average external rotation angle was 71° (ranged, 63.5° to 83.5°), the average internal rotation angle was 73.6 ° (ranged, 68° to 79°) and the recovery of mobility was good. The complication rate of MIPPO group was 5.56%, which was better than that of ORIF group 11.90% (P<0.05). Conclusion Both MIPPO and ORIF can treat proximal humerus fractures of Neer type Ⅲ and Ⅳ. The former is superior to the latter in incision length, bleeding volume, fracture healing time, shoulder joint function recovery at 3 and 6 months after operation, complications and other aspects, which is worth clinical promotion. Key words: Humeral fractures; Fracture fixation,internal; Axillary nerve injury; Minimal invasive

Axillary nerve elongation in humeral fracture plating: A cadaveric study for comparison between straight and helical Philos plates

ObjectiveHelical plating is a known concept in humeral fracture treatment. Attention should be paid to the axillary nerve when inserting a plate underneath the deltoid muscle. The purpose of this cadaveric study was to estimate axillary nerve stretching when introducing the plate. Methods: On 42 fresh frozen human humeri, an 8-, 10- and 12-hole Philos plate in a straight and a helical shape were compared measuring the maximum plate-bone-distance. Results: For all three plate lengths, the helical plates had a significantly lower plate-bone-distance. Conclusion: Indirectly, this suggests a lower axillary nerve elongation and hence less chance of nerve damage.

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty

Objective To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly. Methods Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed. There were 12 males and 31 females with an average age of 72 years (range, 66-78 years). All fractures were fresh and close which caused by trauma. The average time from injury to operation was 8.0 days (range, 6-11 days). According to Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, 22 cases (51.2%, 22/43) four-part fractures. Visual analogue scale (VAS), Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results. Results All operations were successfully completed. The average operation time was 141.3 minutes (range, 120-170 minutes. The mean blood loss was 407 ml (range, 250-700 ml) and intraoperative blood transfusion was 446.5 ml (range, 400-800 ml). All patients were followed up for 10.9 months (range, 6 to 16 months). All patients were discharged within 7 days after operation, and no wounds related complications occurred. The bigger and lesser tuberosities of all patients healed completely within 8 weeks. At the latest follow-up, no loosening or dislocation of prosthesis occurred, and the forward elevation was 133.0° (range, 100°-165°); external rotation was 29.5° (range, 20°-35°); internal rotation was 46.7° (range, 30°-60°). VAS score was 0.8 (range, 0-3). The Neer score was 87 (range, 73-98), with 20 cases (46.5%, 20/43) excellent, 16 cases (37.2%, 16/43) good, and 7 cases (16.3%, 7/43) fair. Constant-Murley score was 88.7 (range, 70-98). A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation, which did not affect the functional rehabilitation exercise or the stability of the prosthesis. During the follow-up, no other complications such as infection, acromial stress fracture and scapular notching were found in all patients. Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory. Key words: Aged; Humeral fractures; Arthroplasty, replacement

Humeral interlocking intramedullary nailing without image intensifier in a developing country

Background: Interlocking intramedullary nailing under image intensifier has been a standard approach to surgical treatment of humeral fractures. Aim: We present the outcome of humeral interlocking nailing without image intensifier in a developing country. Materials and Methods: This is a prospective study of consecutive patients with humeral shaft fractures who were treated with Surgical Implant Generation Network interlocking nailing for humeral shaft fractures using an external jig system. They were followed up for at least 6 months if there was no evidence of fracture healing and restoration of functional activities. Data collected were processed with the Statistical Package for the Social Sciences and summarised in percentages and means. Results: Forty-five patients with 46 humeral shaft fractures were studied, with a mean age and standard deviation of 46 ± 14.6 years and male-female ratio of 1.8:1. At 3 months, 44 (95.7%) of the patients have had radiographic evidence of fracture healing. Over the same period, 35 (76.1%) of them had achieved shoulder abduction >90°, 37 (80.5%) had achieved painless shoulder flexion-abduction-external rotation movement and 42 (91.3%) had achieved full activities of daily living. Conclusion: In a resource-constrained population where image intensifier is difficult to come by, humeral interlocking intramedullary nailing could still be performed using external jig system with a satisfactory outcome.

Clinical comparative study of metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture

Objective To investigate the difference of clinical efficacy between metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture. Methods 64 patients with Neer II humeral surgical neck fracture who were treated in our hospital from January 2010 to December 2015 were selected. According to the operation plan, the patients were divided into epiphyseal locking intramedullary nail fixation group (observation group, n=42) and locking plate fixation group (control group, n=22). The differences of clinical data (sex, age, time from injury to operation, number of injured cases, follow-up time), clinical indicators (neck-trunk angle, last neck-trunk angle, number of complications, amount of operative bleeding, amount of operative blood transfusion, operation time, fracture healing time): Neer shoulder function score and Constant shoulder score were compared between the two groups. Results There was no significant difference in gender, age, time from injury to operation, number of cases of injury and follow-up time between the two groups, and the subjects were comparable (P>0.05). There was no significant difference in the neck-trunk angle, the last neck-trunk angle and the number of complications between the two groups (P>0.05); the observation group had longer operation time, less operation bleeding volume and blood transfusion volume, shorter fracture healing time (P 0.05). The Constant score, external rotation, abduction and flexion in the observation group were significantly higher than those in the control group (P<0.05). Conclusions The use of metaphyseal locking intramedullary nail in the treatment of humeral surgical neck fracture has a definite clinical effect and a low incidence of complications, which is worthy of clinical application. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, intramedullary; Bone nails; Bone plates

Humeral fracture treatment in pigeons by bone pins made from ovine and canine bones

The tubular, pneumatic long bones of the bird present unique challenges in veterinary orthopedics. Various traditional and innovative forms of fracture fixation have been applied in bird orthopedic. The purpose of this study was to compare the applicability of the stainless steel intra-medullary pin with the pins made from ovine and canine long bones. Ovine and canine long bones were used to prepare pins in appropriate size and dimension. The pins were treated chemically, hydrated, dried, packaged and sterilized by ethylene oxide. Forty domestic male pigeons were divided into four equal groups. Pigeons were anesthetized by combination of xylazine and ketamine. Humeral bones were cut by a diamond disc burr. In the first group the fractured bones were not treated and was regarded as control group. In the second group stainless steel pins were inserted into the humeral medulla of pigeons; and in the third and fourth groups, prepared pins from ovine and canine long bones were inserted into the medulla, respectively. The operated wing was bandaged to the body and stabilized. Post-operative care included: clinical assessment of surgical wound, wing holding and flight assessment. The flight behavioral assessment and radiographic studies were carried out every two weeks for 32 weeks.After 32 weeks the pigeons of the first group were not able to fly, in the second group pigeons had imbalance in flight; and in the third and fourth groups the pigeons were able to fly with no problem. Radiographic study showed no significant differences between groups 2, 3 and 4 but there was a significant difference between group 1 and other three groups. None of the bone pins were rejected; all were absorbed in later stages in large quantities.The IM pins made from long bones of sheep and dog pins can be considered as an appropriate and alternative internal fixation technique, because they are very firm, strong, provide very good internal fixation for bone alignment, showing no tissue sensitivity, no rejection and therefore not necessity to be removed. While the stainless steel IM pin creates imbalance in flight and they have to be removed after bone union is completed, which needs another surgical intervention and stress.

CLINICAL OUTCOMES OF ANTERIOR BRIDGE PLATING FOR HUMERUS SHAFT FRACTURES BY MINIMAL INVASIVE TECHNIQUE

Near normal acceptable reduction and rigid stable fixation has its biological advantage as compare to absolute anatomical reduction with compromising soft tissue and vascularity. Biological fixation of fractures with soft tissue preservation and near acceptable reduction is becoming a more acceptable entity. However it is to be evaluated. For a satisfactorily outcome only union is not the only requirement but early and acceptable functional usage of the limb is the goal. Therefore concept of biological fixation was developed over a stable mechanical fixation. This has evolved the development and improvement in the techniques of biological fracture fixation and stabilization systems. From conservative cast and braces to internal fixation with intramedullary interlocking nailing, ORIF with plate and screw. Treatment of humeral fracture has evolved a lot with their complications. Studies are still going on to prove superiority of one over another. Minimally invasive technique for humerus shaft fracture has shown promising results recently.&#x0D; The present study was planned in Department of Orthopaedic, Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar from jan 2017 to Oct 2017. Total 10 cases with fractures of humerus shaft were treated with Minimum invasive Anterior Bridge plating techniques were evaluated in the present study.&#x0D; The data generated from the present study concludes that though the technique is very promising, it has a steep learning curve involved. The greatest advantage is minimally invasive, minimal soft tissue stripping, smaller incisions, minimal blood loss, shorter operative time and early rehabilitation. In conclusion anterior bridge plating (ABP) is very good technique in treating midshaft humeral fractures with minimal soft tissue dissection, smaller scars, and early return to overhead activities.&#x0D; Keywords: Anterior bridge plate, humerus fracture, minimal invasive technique, minimal invasive procedure, etc.

Comparison of clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by either parallel or orthogonal double plating

Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P 0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P 0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients. Key words: Humeral fractures; Young people; Elderly; Fracture fixation, internal; Bone plates

Efficacy comparison between plate fixation with in situ reinforcing ulnar nerve and anterior transposition for humeral intercondylar fracture

Objective To investigate the clinical efficacy of plate fixation with in situ reinforcing ulnar nerve and anterior transposition by olecranon osteotomy approach in the treatment of type C2 and C3 humeral intercondylar fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 23 patients with humeral intercondylar fractures admitted to the Affiliated Hospital of Hangzhou Normal University from June 2014 to January 2017. There were 17 males and six females, aged 19-56 years, with an average of 41.2 years. According to AO classification, there were 15 patients with type C2 and eight with type C3. All patients were treated with plate internal fixation by olecranon osteotomy approach. The patients were divided into anterior group (11 patients) which was treated with ulnar nerve release anterior transposition and in situ reinforcing group (12 patients) which was treated with ulnar nerve release in situ. The operation time, intraoperative blood loss, fracture healing time, elbow flexion and extension range, elbow joint Mayo score, and excellent and good rate were compared between the two groups. Postoperative complications were recorded. Results All patients were followed up for 15-43 months, with an average of 26.7 months. All patients had no need of blood transfusion. There were no significant differences between anterior group and in situ reinforcing group in operation time [(219.1±15.1)minutes vs. (211.2±17.1)minutes], intraoperative blood loss [(263.6±35.3)ml vs. (237.5±25.6)ml] and fracture healing time [(18.2±2.4)weeks vs. (18.9±1.7)weeks] (P>0.05). No significant differences were found between the two groups in elbow flexion [(120.3±7.1)° vs. (120.3±4.1)°], straightness [(3.7±2.7)° vs. (4.1±2.4)°], Mayo score [(89.09±9.17)points vs. (86.67±10.29)points] and excellent and good rate [ 91% (10/12) vs. 83% (10/12)] (P>0.05). After operation, no complications such as infection, heterotopic ossification, ulnar neuritis, elbow valgus deformity, or internal fixation failure occurred. Conclusions For humeral intercondylar fracture, the plate fixation with in situ reinforcing ulnar nerve and anterior transposition by olecranon osteotomy approach both have advantages such as small surgical trauma, strong fixation, fewer complications, satisfactory recovery of elbow function. Ulnar nerve anterior transposition or not does not affect the occurrence of ulnar neuritis, and both can obtain satisfactory clinical efficacy. Key words: Humeral fractures; Intra-articular fractures; Fracture fixation, internal; Ulnar nerve