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Archives of Orthopaedic and Trauma... Aug 2023Humeral 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... (Review)
Review
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 -
Journal of Orthopaedic Surgery and... Sep 2021Distal humerus fractures (DHFs) constitute one-third of elbow fractures approximately. In this study, we aim to define and analyze the fracture lines and morphological...
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 -
Ugeskrift For Laeger Jan 2023The 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... (Review)
Review
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 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Aseptic humeral shaft nonunions are rare lesions, with less than 700 cases per year in France. This low frequency explains why they are difficult to manage. They can be... (Review)
Review
Aseptic humeral shaft nonunions are rare lesions, with less than 700 cases per year in France. This low frequency explains why they are difficult to manage. They can be hypertrophic or atrophic, with or without a defect. The diagnosis is made based on radiographs and/or CT scan images. Nonunion is suspected early on when a patient presents with abnormal motion at the fracture site 6 weeks after the initial injury event in the context of conservative treatment or has large residual displacement after initial treatment or an open fracture. The treatment for hypertrophic nonunion consists in applying stable, rigid fixation, most often using a large-fragment plate with 4.5 mm screws, combined with cancellous autograft. When combined with the osteoperiosteal decortication first described by Judet, it produces union in 98% of cases. Intramedullary (IM) nail fixation with an autograft is another possibility. In atrophic nonunions, resecting the ends and ensuring the soft tissues have good vitality will generally lead to fracture union. Nonunions with critical size defects (larger than 5 cm), which have a high risk of infection, are a treatment challenge that requires stable fixation and recourse to more complex treatments like the two-step induced membrane technique or vascularized fibular graft. In all cases, to avoid complex repeat revision, internal fixation with plate or IM nail must be combined with a bone graft in situ to maximize the chances of union.
Topics: Humans; Humeral Fractures; Fractures, Ununited; Fracture Fixation, Internal; Humerus; Bone Plates; Bone Transplantation; Treatment Outcome; Retrospective Studies; Fracture Healing
PubMed: 36942794
DOI: 10.1016/j.otsr.2022.103462 -
BMC Surgery Oct 2021Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that...
BACKGROUND
Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed.
METHODS
Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months.
RESULTS
The average operation time was 108 min (range, 70-130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8-16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68-92) during the final visit.
CONCLUSIONS
The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; Humans; Humeral Fractures; Shoulder Fractures; Treatment Outcome
PubMed: 34719385
DOI: 10.1186/s12893-021-01388-9 -
Journal of Feline Medicine and Surgery Jun 2022The 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...
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 -
Orthopaedics & Traumatology, Surgery &... Feb 2015Humeral shaft fractures account for up to 5% of all fractures. Many of these fractures are still being treated conservatively using functional (Sarmiento) bracing or a... (Review)
Review
Humeral shaft fractures account for up to 5% of all fractures. Many of these fractures are still being treated conservatively using functional (Sarmiento) bracing or a hanging arm cast. Union is achieved in 10 weeks in more than 94% of cases. Angulation of less than 30° varus or valgus and less than 20° flessum or recurvatum can be tolerated by the patient from a functional and esthetic point of view. The ideal candidate for this treatment is a patient with an isolated fracture. Plate and screw fixation of the fracture results in union in 11 to 19 weeks. Reported complications include non-union (2.8-21%), secondary radial nerve palsy (6.5-12%) and infection (0.8-2.4%). Anterograde or retrograde locked intramedullary nailing requires knowledge of nailing techniques and regional anatomy to avoid the complications associated with the technique. Union is obtained in 10-15 weeks. Reported complications consist of non-union (2-17.4%), infection (0-4%) and secondary radial nerve palsy (2.7-5%). Hackethal bundle nailing is still used for fracture fixation, despite an elevated complication rate (5-24% non-union and 6-29% pin migration) because of its low cost and simple instrumentation. Union is achieved in 8-9 weeks. Controversy remains about the course to follow when the radial nerve is injured initially. If the fracture is open, significantly displaced, associated with a vascular injury or requires surgical treatment, the nerve must be explored. In other cases, the recommended approach varies greatly. Conservative treatment is inexpensive and has a low complication rate. Humeral shaft fractures are increasingly being treated surgically, at a greater cost and higher risk of complications.
Topics: Adult; Bone Nails; Bone Plates; Braces; Casts, Surgical; External Fixators; Fracture Fixation, Internal; Fractures, Ununited; Humans; Humeral Fractures; Humerus; Immobilization; Prosthesis-Related Infections; Radial Neuropathy
PubMed: 25604002
DOI: 10.1016/j.otsr.2014.07.034 -
Clinical Medicine & Research Jun 2023Humeral fractures in arm wrestling are rarely reported entities in the orthopedic literature and can present with significant pain and debilitation. These injuries are... (Review)
Review
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 -
BMC Musculoskeletal Disorders Jan 2022Most fractures in children are fractures of the upper extremity. Proximal and diaphyseal humeral fractures account for a minority of these fractures. To our knowledge,... (Observational Study)
Observational Study
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 -
Annals of the Royal College of Surgeons... Oct 2020Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated...
Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated inflammatory markers. No significant improvement was seen with concomitant intravenous antibiotics and multiple debridement procedures. This case was further complicated by soft tissue breakdown at the site of a left thigh haematoma also requiring debridement. Surgical site infections represent the most common cause of morbidity postoperatively. This case highlights the importance of considering a number of differential diagnoses. A diagnosis of pyoderma gangrenosum prompted systemic corticosteroid therapy giving rapid clinical improvement.
Topics: Aged; Debridement; Diagnosis, Differential; Fracture Fixation, Internal; Humans; Humeral Fractures; Male; Open Fracture Reduction; Pyoderma Gangrenosum; Thigh
PubMed: 32347737
DOI: 10.1308/rcsann.2020.0091