Review

Authors: Saskia H Van Bergen, Kiran C Mahabier, Esther M M Van Lieshout...

INTRODUCTION

Humeral shaft fractures can be treated non-operatively or operatively. The optimal management is subject to debate. The aim was to compare non-operative and operative treatment of a humeral shaft fracture in terms of fracture healing, complications, and functional outcome.

METHODS

Databases of Embase, Medline ALL, Web-of-Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for publications reporting clinical and functional outcomes of humeral shaft fractures after non-operative treatment with a functional brace or operative treatment by intramedullary nailing (IMN; antegrade or retrograde) or plate osteosynthesis (open plating or minimally invasive). A pooled analysis of the results was performed using MedCalc.

RESULTS

A total of 173 studies, describing 11,868 patients, were included. The fracture healing rate for the non-operative group was 89% (95% confidence interval (CI) 84-92%), 94% (95% CI 92-95%) for the IMN group and 96% (95% CI 95-97%) for the plating group. The rate of secondary radial nerve palsies was 1% in patients treated non-operatively, 3% in the IMN, and 6% in the plating group. Intraoperative complications and implant failures occurred more frequently in the IMN group than in the plating group. The DASH score was the lowest (7/100; 95% CI 1-13) in the minimally invasive plate osteosynthesis group. The Constant-Murley and UCLA shoulder score were the highest [93/100 (95% CI 92-95) and 33/35 (95% CI 32-33), respectively] in the plating group.

CONCLUSION

This study suggests that even though all treatment modalities result in satisfactory outcomes, operative treatment is associated with the most favorable results. Disregarding secondary radial nerve palsy, specifically plate osteosynthesis seems to result in the highest fracture healing rates, least complications, and best functional outcomes compared with the other treatment modalities.

Topics: Humans; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humeral Fractures; Fracture Healing; Bone Plates; Radial Neuropathy; Humerus; Treatment Outcome

PubMed: 37093269
DOI: 10.1007/s00402-023-04836-8

Authors: Chao Wang, Yong Zhu, Haitao Long...

BACKGROUND

Distal humerus fractures (DHFs) constitute one-third of elbow fractures approximately. In this study, we aim to define and analyze the fracture lines and morphological features of DHFs using mapping technique.

METHODS

One hundred and two DHFs were retrospectively reviewed. All the computed tomography (CT) data were used to manually reconstruct and virtually reduce the DHF fragments to fit a standard 3D model. Smooth curves were depicted accurately onto the surface of the template to represent the fracture lines. All the curves were overlapped onto the model to create the 3D fracture map and heat map.

RESULTS

Our analysis was based on 102 CT images of DHFs, contributed by 59 male and 43 female patients (mean age, 46 years; range, 18-93 years), and included 15 type A, 25 type B, and 62 type C fractures. On mapping, the hot zones were located in the radial fossa, coronoid fossa, olecranon fossa, and the external part of the trochlear. Conversely, the cold zones were noted in medial condyle, the medial side of the trochlear, and the anterolateral area on the supracondylar ridge.

CONCLUSIONS

Our study firstly shows the fracture lines and morphological features of distal humeral fractures by three-dimensional mapping technology. Distal humerus fracture lines are characteristic and highly related to the micro-architecture difference of distal humerus, which may provide some guidance for the treatment plan selection and surgical fixation design.

Topics: Elbow Joint; Epiphyses; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Humeral Fractures; Humerus; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed

PubMed: 34479569
DOI: 10.1186/s13018-021-02691-0

Review

Authors: Morten Jon Andersen

The supracondylar humerus fracture is the most common elbow fracture in children. All orthopedic surgeons involved in pediatric trauma will at some point have to treat this injury. Severity ranges from simple fractures to limb threatening injuries. An in-depth knowledge of this injury is key to a successful treatment outcome. This review describes the diagnostic approach and current concepts for treatment of pediatric supracondylar humerus fractures.

Topics: Child; Humans; Humeral Fractures; Treatment Outcome; Retrospective Studies

PubMed: 36760153
DOI: No ID Found

Authors: Nick Gall, Kevin Parsons, Heidi Radke...

OBJECTIVES

The aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures.

METHODS

In total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate.

RESULTS

The majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA ( = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA ( = 0.01). Body weight had a positive correlation ( = 0.398) with time to radiographic healing and time to acceptable function ( = 0.315), and was significant ( = 0.014 and  = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate-rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications ( = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups ( = 0.012). There was no significant difference between fixation groups in time to radiographic union ( = 0.145) or time to acceptable function ( = 0.306).

CONCLUSIONS AND RELEVANCE

All three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

Topics: Accidents, Traffic; Animals; Bone Plates; Cats; Diaphyses; External Fixators; Female; Fracture Fixation; Fracture Fixation, Internal; Humeral Fractures; Male; Prognosis; Treatment Outcome

PubMed: 35254143
DOI: 10.1177/1098612X221080600

Observational Study

Authors: Sarah Daag Jacobsen, Richard Marsell, Olof Wolf...

BACKGROUND

Most fractures in children are fractures of the upper extremity. Proximal and diaphyseal humeral fractures account for a minority of these fractures. To our knowledge, few previous reports address these fractures. This study aimed to describe the epidemiology and current treatment of proximal and diaphyseal humeral fractures by using the Swedish Fracture Register (SFR).

METHODS

In this nationwide observational study from the SFR we analysed data on patient characteristics, injury mechanism, fracture classification and treatment. We included patients aged < 16 years at time of injury with proximal or diaphyseal humeral fracture registered in 2015-2019.

RESULTS

1996 (1696 proximal and 300 diaphyseal) fractures were registered. Proximal fractures were more frequent in girls whereas diaphyseal fractures were more frequent in boys. The median age at fracture was 10 years in both fracture types but patient's age was more widespread in diaphyseal fracture (IQR 5-13 compared to IQR 7-12 in proximal). In both sexes, the most registered injury mechanism was fall. Horse-riding was a common mechanism of injury in girls, whereas ice-skating and skiing were common mechanisms in boys. Most proximal fractures were metaphyseal fractures. Most diaphyseal fractures were simple transverse or oblique/spiral fractures. The majority of fractures were treated non-surgically (92% of proximal and 80% of diaphyseal fractures). The treatment method was not associated with the patient's sex. Surgery was more often performed in adolescents. The most common surgical methods were K-wire and cerclage fixation in proximal fracture and intramedullary nailing in diaphyseal fracture.

CONCLUSION

Following falls, we found sex-specific sport activities to cause most proximal and diaphyseal paediatric fractures. Further studies on prophylactic efforts in these activities are needed to investigate whether these fractures are preventable. The majority of the fractures were treated non-surgically, although surgical treatment increased with increasing age in both sexes.

TRIAL REGISTRATION

Not applicable. The present study is a register-based cohort study. No health care intervention had been undertaken.

Topics: Adolescent; Animals; Child; Cohort Studies; Diaphyses; Female; Fracture Fixation, Intramedullary; Horses; Humans; Humeral Fractures; Male; Sweden

PubMed: 35090422
DOI: 10.1186/s12891-022-05042-0

Review

Authors: Mohamad Y Fares, Joseph A Abboud

Humeral fractures in arm wrestling are rarely reported entities in the orthopedic literature and can present with significant pain and debilitation. These injuries are even more uncommon in female practitioners of the sport. Rotational forces applied to the humerus during competition can result in the transmission of stress into the distal part of the humerus, thereby causing a spiral fracture. Common complications that can arise from such an injury can include radial nerve palsy and butterfly fragments of the humerus. These can occur in arm wrestling and can present with prominent pain, weakness, and functional impairment. Treatment often varies according to the presenting case and are often operative in cases with displaced fractures, and non-operative in those of nondisplaced fractures. Prognostic outcomes are often favorable and uneventful. In this article, we explore a distal humeral fracture in a female arm wrestler and discuss the mechanism, presentation, and management of such an injury, based on a thorough yet concise review of literature.

Topics: Humans; Female; Arm; Humeral Fractures; Humerus; Radial Neuropathy; Patient-Centered Care; Retrospective Studies

PubMed: 37407215
DOI: 10.3121/cmr.2023.1787

Authors: Katie Kemp, Rami Radwan, Guy Shingler...

We describe a case of an elderly man who presented with an upper arm swelling that had developed following a humeral fracture 8 months previously. The swelling was painless but associated with significantly diminished motor function of his right hand and concurrent paraesthaesia. On examination, a large pulsatile mass was identified and CT angiography confirmed the presence of an 11×7 cm brachial artery pseudoaneurysm. The patient underwent surgical repair in which a fragment of the humerus was found to have punctured the brachial artery resulting in a pseudoaneurysm. The patient had an uncomplicated postoperative period and was discharged 2 days later having regained some motor function in his right hand.

Topics: Aged, 80 and over; Aneurysm, False; Angiography; Brachial Artery; Humans; Humeral Fractures; Humerus; Male

PubMed: 24859555
DOI: 10.1136/bcr-2014-203924

Authors: Carl Bergdahl, Carl Ekholm, David Wennergren...

BACKGROUND

Humeral fractures are common, but the association between the patho-anatomical fracture pattern and patient characteristics has been inadequately studied and epidemiological knowledge is scarce. Following the introduction of the Swedish Fracture Register (SFR), risk factors for various fractures can be studied, as well as the outcome of different treatments. The objective of this study was to analyse adult humeral fractures in Gothenburg from a descriptive epidemiological perspective.

METHODS

All humeral fractures registered in the SFR at Sahlgrenska University Hospital in 2011-2013 in patients aged ≥ 16 years were included. The fractures were divided into humeral segments (proximal, shaft and distal humerus) and analysed according to patient characteristics and patho-anatomical pattern. Furthermore, overall and age-specific incidence rates were calculated.

RESULTS

A total of 2,011 humeral fractures were registered in the SFR, of which 79% were proximal, 13% shaft and 8% distal humeral fractures. The mean age was 66.8 years and women ran a higher risk of humeral fractures than men (female/male ratio 2.4:1). On average, women were older than men at the time of fracture (mean age 70.1 years for women vs. 58.9 years for men). The overall incidence of humeral fractures was 104.7 per 100,000 inhabitants per year, with a segment-specific incidence of 83.0 for proximal fractures, 13.4 for shaft fractures and 8.3 per 100,000 person-years for distal fractures. There was a distinct increase in the age-specific incidence from the fifth decade and onwards, regardless of fracture site. Most fractures occurred in older patients (83% > 50 years) as a result of a simple or an unspecified fall (79% > 50 years). Only 1.2% of all fractures were open injuries and 1.3% were pathological.

CONCLUSION

This population-based study provides updated epidemiological data on humeral fractures in a Western-European setting. Most humeral fractures occur as the result of low-energy falls in the elderly population, indicating the influence of age-related risk factors in these fractures. The SFR will be a useful tool for providing continuous information on fracture epidemiology, risk factors and treatment outcome and these population-based data are essential in the planning of future fracture prevention and management.

Topics: Accidental Falls; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Humeral Fractures; Male; Middle Aged; Prospective Studies; Registries; Risk Factors; Sweden; Young Adult

PubMed: 27072511
DOI: 10.1186/s12891-016-1009-8

Meta-Analysis Review

Comparison of Minimally Invasive Percutaneous Plate Osteosynthesis and Open Reduction Internal Fixation on Proximal Humeral Fracture in Elder Patients: A Systematic Review and Meta-Analysis.

Authors: Wei Zhao, Yuhui Zhang, Dongni Johansson...

OBJECTIVE

The study aims to compare minimally invasive percutaneous plate osteosynthesis (MIPO) and open reduction internal fixation (ORIF) in the treatment of proximal humeral fracture in elder patients.

METHOD

PubMed, Medline, EMbase, Ovid, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wangfang, and VIP Database for Chinese Technical Periodicals were searched to identify all relevant studies from inception to October 2016. Data were analyzed with Cochrane Collaboration's Review Manage 5.2.

RESULTS

A total of 630 patients from 8 publications were included in the systematic review and meta-analysis. The pooled results showed that MIPO was superior to ORIF in the treatment of proximal humeral fracture in elder patients. It was reflected in reducing blood loss, operation time, postoperative pain, or fracture healing time of the surgery and in improving recovery of muscle strength. Concerning complications, no significant difference was seen between MIPO and ORIF.

CONCLUSION

The MIPO was more suitable than ORIF for treating proximal humeral fracture in elder patients.

Topics: Aged; Aged, 80 and over; Female; Fracture Fixation, Internal; Humans; Humeral Fractures; Male; Minimally Invasive Surgical Procedures

PubMed: 28698871
DOI: 10.1155/2017/3431609

Authors: Oliver J Anderson, Sorrel J Langley-Hobbs, Kevin J Parsons...

OBJECTIVE

To report the configuration, risk factors, fixation methods and complication rates after repair of humeral condylar fractures (HCF) in French bulldogs, and report the presence of humeral intracondylar fissures (HIF) in this population as a possible predisposing factor.

STUDY DESIGN

Retrospective clinical cohort study.

SAMPLE POPULATION

Forty-four elbows.

METHODS

The medical records of dogs referred between January 2012 and December 2021 were searched for French bulldogs presenting with HCF. Signalment, fracture configuration, stabilization method and complication occurrence were obtained. Postoperative radiographs were assessed for implant positioning, and computed tomography (CT) scans were assessed for the presence and size of HIF in the contralateral elbow.

RESULTS

Lateral humeral condylar fractures represented 28/44 (63.6%) of HCF in French bulldogs. Repair with a transcondylar screw (TCS) and Kirschner-wire(s) (K-wire) were 7.62 times more likely to result in a major complication (95% CI: 1.43, 21.89; p = .01) compared to other methods. All incidences (7/7) of TCS migration were within the TCS + K-wire group. A HIF was identified in 18/31 (58.1%) dogs. Older animals were not significantly less likely to have a HIF than younger animals (p = .129).

CONCLUSIONS

Fracture stabilization with a TCS and K-wire(s) was associated with an increased risk of major complications and migration of the TCS. A HIF was present in the contralateral elbow of over half of the French bulldogs where CT was available.

CLINICAL SIGNIFICANCE

A HIF may be a predisposing factor of HCF in French bulldogs. Alternative methods of stabilization to a TCS and K-wire(s) should be used to reduce complication risk.

Topics: Dogs; Animals; Retrospective Studies; Cohort Studies; Fracture Fixation, Internal; Humeral Fractures; Humerus; Treatment Outcome; Dog Diseases

PubMed: 36222446
DOI: 10.1111/vsu.13907