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Levasseur J, Bordure P, Moui Y, David G, Rony L. Does double distal locking reduce non-union rates in intramedullary nailing for humeral shaft fracture? Orthop Traumatol Surg Res 2025; 111:103913. [PMID: 38848890 DOI: 10.1016/j.otsr.2024.103913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Intramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10-20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking. HYPOTHESIS Nailing with double distal locking decreases non-union rates compared to single or no locking. MATERIAL AND METHODS This single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs). RESULTS There were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (p=0.32). Constant score at 6 months was significantly different between the 3 groups (p=0.01). Group 2 used more NSAIDs than the other groups (39.1% vs. 20.0% in group 1 and 33.3% in group 3; p=0.37). DISCUSSION Non-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Jules Levasseur
- Département de chirurgie osseuse, CHU d'Angers, 4, Rue Larrey, 49933 Angers cedex 9, France
| | - Pierre Bordure
- Service de chirurgie de l'épaule, clinique Saint-Léonard, 18, rue de Bellinière, 49800 Trélazé, France
| | - Yvon Moui
- Service de chirurgie orthopédique, centre hospitalier du Mans, 194, avenue Rubillard, 72037 Le Mans, France
| | - Guillaume David
- Département de chirurgie osseuse, CHU d'Angers, 4, Rue Larrey, 49933 Angers cedex 9, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU d'Angers, 4, Rue Larrey, 49933 Angers cedex 9, France.
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Li Y, Luo Y, Peng J, Fan J, Long XT. Clinical effect of operative vs nonoperative treatment on humeral shaft fractures: Systematic review and meta-analysis of clinical trials. World J Orthop 2024; 15:783-795. [PMID: 39165869 PMCID: PMC11331324 DOI: 10.5312/wjo.v15.i8.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/05/2024] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable. We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes. AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures. METHODS We searched the PubMed, Web of Science, ScienceDirect, and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures. Two investigators independently extracted data from the eligible studies, and the other two assessed the methodological quality of each study. The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale. The nonunion, reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software (version 5.3). RESULTS A total of four randomized control trials and 13 cohort studies were included, with 1285 and 1346 patients in the operative and nonoperative groups, respectively. Patients in the operative group were treated with a plate or nail, whereas those in the conservative group were managed with splint or functional bracing. Four studies were assessed as having a high risk of bias, and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool. The operative group had a significantly decreased rate of nonunion [odds ratio (OR) 0.30; 95%CI: 0.23 to 0.40), reintervention (OR: 0.33; 95%CI: 0.24 to 0.47), and overall complications (OR: 0.62; 95%CI: 0.49 to 0.78)]. The pooled effect of the Disabilities of Arm, Shoulder, and Hand score showed a significant difference at 3 [mean difference (MD) -8.26; 95%CI: -13.60 to -2.92], 6 (MD: -6.72; 95%CI: -11.34 to -2.10), and 12 months (MD: -2.55; 95%CI: -4.36 to -0.74). The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups. CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
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Affiliation(s)
- Yang Li
- Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
| | - Yi Luo
- Department of Orthopedics, Bishan Hospital of Chongqing, Chongqing 402760, China
| | - Jing Peng
- Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
| | - Jun Fan
- Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
| | - Xiao-Tao Long
- Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
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Surgical Versus Nonsurgical Management of Humeral Shaft Fractures: A Systematic Review and Meta-Analysis of Randomized Trials. J Am Acad Orthop Surg 2023; 31:e82-e93. [PMID: 36580054 DOI: 10.5435/jaaos-d-22-00432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/06/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The aim was to compare surgical and nonsurgical management for adults with humeral shaft fractures in terms of patient-reported upper limb function, health-related quality of life, radiographic outcomes, and complications. METHODS MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, International Clinical Trials Registry, and OpenGrey (Repository for Grey Literature in Europe) were searched in September 2021. All published prospective randomized trials comparing surgical and nonsurgical management of humeral shaft fractures in adults were included. Of 715 studies identified, five were included in the systematic review and four in the meta-analysis. Data were extracted by two independent reviewers according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Methodological quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Pooled data were analyzed using a random-effects model. RESULTS The meta-analysis comprised 292 patients (mean age 41 [18 to 83] years, 67% male). Surgery was associated with superior Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores at 6 months (mean DASH difference 7.6, P = 0.01; mean Constant-Murley difference 8.0, P = 0.003), but there was no difference at 1 year (DASH, P = 0.30; Constant-Murley, P = 0.33). No differences in health-related quality of life or pain scores were found. Surgery was associated with a lower risk of nonunion (0.7% versus 15.7%; odds ratio [OR] 0.13, P = 0.004). The number needed to treat with surgery to avoid one nonunion was 7. Surgery was associated with a higher risk of transient radial nerve palsy (17.4% versus 0.7%; OR 8.23, P = 0.01) but not infection (OR 3.57, P = 0.13). Surgery was also associated with a lower risk of reintervention (1.4% versus 19.3%; OR 0.14, P = 0.04). CONCLUSIONS Surgery may confer an early functional advantage to adults with humeral shaft fractures, but this is not sustained beyond 6 months. The lower risk of nonunion should be balanced against the higher risk of transient radial nerve palsy. LEVEL OF EVIDENCE Level I.
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Functional and clinical outcome after operative versus nonoperative treatment of a humeral shaft fracture (HUMMER): results of a multicenter prospective cohort study. Eur J Trauma Emerg Surg 2022; 48:3265-3277. [PMID: 35138426 PMCID: PMC9360107 DOI: 10.1007/s00068-022-01890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
Abstract
Purpose The best treatment of humeral shaft fractures in adults is still under debate. This study aimed to compare functional and clinical outcome of operative versus nonoperative treatment in adult patients with a humeral shaft fracture. We hypothesized that operative treatment would result in earlier functional recovery. Methods From October 23, 2012 to October 03, 2018, adults with a humeral shaft fracture AO type 12A or 12B were enrolled in a prospective cohort study in 29 hospitals. Patients were treated operatively or nonoperatively. Outcome measures were the Disabilities of the Arm, Shoulder, and Hand score (DASH; primary outcome), Constant–Murley score, pain (Visual Analog Score, VAS), health-related quality of life (Short Form-36 (SF-36) and EuroQoL-5D-3L (EQ-5D)), activity resumption (Numeric Rating Scale, NRS), range of motion (ROM) of the shoulder and elbow joint, radiologic healing, and complications. Patients were followed for one year. Repeated measure analysis was done with correction for age, gender, and fracture type. Results Of the 390 included patients, 245 underwent osteosynthesis and 145 were primarily treated nonoperatively. Patients in the operative group were younger (median 53 versus 62 years; p < 0.001) and less frequently female (54.3% versus 64.8%; p = 0.044). Superior results in favor of the operative group were noted until six months follow-up for the DASH, Constant–Murley, abduction, anteflexion, and external rotation of the shoulder, and flexion and extension of the elbow. The EQ-US, and pronation and supination showed superior results for the operative group until six weeks follow-up. Malalignment occurred only in the nonoperative group (N = 14; 9.7%). In 19 patients with implant-related complications (N = 26; 10.6%) the implant was exchanged or removed. Nonunion occurred more often in the nonoperative group (26.3% versus 10.10% in the operative group; p < 0.001). Conclusion Primary osteosynthesis of a humeral shaft fracture (AO type 12A and 12B) in adults is safe and superior to nonoperative treatment, and should therefore be the treatment of choice. It is associated with a more than twofold reduced risk of nonunion, earlier functional recovery and a better range of motion of the shoulder and elbow joint than nonoperative treatment. Even after including the implant-related complications, the overall rate of complications as well as secondary surgical interventions was highest in the nonoperative group. Trial registration NTR3617 (registration date 18-SEP-2012). Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01890-6.
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Oliver WM, Searle HKC, Ng ZH, Molyneux SG, White TO, Clement ND, Duckworth AD. Factors associated with humeral shaft nonunion. J Shoulder Elbow Surg 2021; 30:2283-2295. [PMID: 33636324 DOI: 10.1016/j.jse.2021.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary aim was to identify patient and injury factors independently associated with humeral diaphyseal fracture nonunion after nonoperative management. The secondary aim was to determine the effect of management (operative/nonoperative) on nonunion. METHODS From 2008-2017, a total of 734 humeral shaft fractures (732 consecutive skeletally mature patients) were retrospectively identified from a trauma database. Follow-up was available for 663 fractures (662 patients, 90%) that formed the study cohort. Patient and injury characteristics were recorded. There were 523 patients (79%) managed nonoperatively and 139 (21%) managed operatively. Outcome (union/nonunion) was determined from medical records and radiographs. RESULTS The median age at injury was 57 (range 16-96) years and 54% (n = 359/662) were female. Median follow-up was 5 (1.2-74) months. Nonunion occurred in 22.7% (n = 119/524) of nonoperatively managed injuries. Multivariate analysis demonstrated preinjury nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] 20.58, 95% confidence interval [CI] 2.12-199.48; P = .009) and glenohumeral arthritis (OR 2.44, 95% CI 1.03-5.77; P = .043) were independently associated with an increased risk of nonunion. Operative fixation was independently associated with a lower risk of nonunion (2.9%, n = 4/139) compared with nonoperative management (OR for nonoperative/operative management 9.91, 95% CI 3.25-30.23; P < .001). Based on these findings, 5 patients would need to undergo primary operative fixation in order to avoid 1 nonunion. CONCLUSIONS Preinjury NSAIDs and glenohumeral arthritis were independently associated with nonunion following nonoperative management of a humeral diaphyseal fracture. Operative fixation was the independent factor most strongly associated with a lower risk of nonunion. Targeting early operative fixation to at-risk patients may reduce the rate of nonunion and the morbidity associated with delayed definitive management.
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Affiliation(s)
- William M Oliver
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK.
| | - Henry K C Searle
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK
| | - Zhan Herr Ng
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK
| | - Samuel G Molyneux
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK
| | - Timothy O White
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK
| | - Nicholas D Clement
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK; Centre for Population and Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Midlothian, UK
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Lode I, Nordviste V, Erichsen JL, Schmal H, Viberg B. Operative versus nonoperative treatment of humeral shaft fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2020; 29:2495-2504. [PMID: 32553853 DOI: 10.1016/j.jse.2020.05.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The humeral shaft fracture accounts for 1%-3% of all fractures and occurs in both the young and old population. However, the optimal treatment is still a matter of debate. Even though nonoperative treatment is commonly considered the gold standard, advantages have been described using operative stabilization. This systematic review aims to compare operative and nonoperative treatment in adult patients with humeral shaft fractures. METHOD We used the following databases: PubMed, Embase, Cochrane, and CINAHL on October 1, 2018, searching for randomized controlled trials (RCTs) and cohort studies. Two reviewers screened the studies using Covidence, followed by systematic data extraction. The primary outcome was defined as posttreatment complications such as nonunion, radial nerve palsy, malunion, and infections. The secondary outcomes were functional scores and patient-reported outcome measures (PROMs). To assess study quality, the risk of bias in nonrandomized studies of interventions and the Cochrane risk of bias tool were used. RESULTS Twelve studies were included: 1 RCT, 1 prospective cohort, and 10 retrospective cohorts with a total of 1406 patients, of whom 835 were treated operatively and 571 nonoperatively. Mean age ranged from 35 to 64, and 54% of the patients were male. The cohort studies had, in general, moderate bias, whereas the RCT had a low bias. There were statistically significant fewer nonunions in the operative treated group with a risk ratio of 0.49 (0.35-0.67), yielding a number needed to treat = 12. There were more deep infections in the operative group with a risk ratio of 2.76 (1.01-7.53) but otherwise no statistical differences concerning malunion or nerve damage. Only 1 study included PROM data. CONCLUSION There were fewer nonunions in the operative group but more deep infections. Because of the lack of studies reporting PROMs, the potential positive effect of operative therapy in early aftercare could not be evaluated. Therefore, PROMs should be mandatory in future comparative studies.
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Affiliation(s)
- Ingunn Lode
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital-Part of Hospital Lillebaelt, Kolding, Denmark.
| | - Vegard Nordviste
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital-Part of Hospital Lillebaelt, Kolding, Denmark
| | - Julie Ladeby Erichsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Hagen Schmal
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital-Part of Hospital Lillebaelt, Kolding, Denmark
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Sargeant HW, Farrow L, Barker S, Kumar K. Operative versus non-operative treatment of humeral shaft fractures: A systematic review. Shoulder Elbow 2020; 12:229-242. [PMID: 32788928 PMCID: PMC7400715 DOI: 10.1177/1758573218825477] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Humeral shaft fractures are common but debate still occurs as to whether these are best managed operatively or non-operatively. We sought to undertake a systematic review and meta-analysis of randomised and non-randomised studies to clarify the optimal treatment. METHODS We performed a search for all randomised and non-randomised comparative studies on humeral shaft fracture. We included only those with an operative and non-operative cohort in adult patients. We undertook a meta-analysis of the following outcome measures: nonunion, malunion, delayed union, iatrogenic nerve injury and infection. Non-operative management was with a functional brace. RESULTS Non-operative management resulted in a significantly higher nonunion rate of 17.6% compared to 6.3% with fixation. Operative management had a significantly higher iatrogenic nerve injury rate of 3.4% and infection rate of 3.7%. All nonunions within the included studies went on to union after plate fixation. There was no significant difference in delayed union or patient reported outcome measures. There was a significantly increased risk of malunion with non-operative treatment however this did not correlate with the outcome. DISCUSSION Our findings suggest that in the majority of cases, humeral shaft fractures can be managed with non-operative treatment, and any subsequent nonunion should be treated with plate fixation.
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Affiliation(s)
- Harry William Sargeant
- Trauma and Orthopaedic Department, Aberden Royal Infirmary, Aberdeen, UK,Harry William Sargeant, NHS Grampian, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB15 6RE, UK.
| | - Luke Farrow
- Trauma and Orthopaedic Department, Aberden Royal Infirmary, Aberdeen, UK,School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Scott Barker
- Trauma and Orthopaedic Department, Aberden Royal Infirmary, Aberdeen, UK
| | - Kapil Kumar
- Trauma and Orthopaedic Department, Aberden Royal Infirmary, Aberdeen, UK
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van de Wall BJM, Ochen Y, Beeres FJP, Babst R, Link BC, Heng M, van der Velde D, Knobe M, Groenwold RHH, Houwert MR. Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. J Shoulder Elbow Surg 2020; 29:1493-1504. [PMID: 32249144 DOI: 10.1016/j.jse.2020.01.072] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/19/2019] [Accepted: 01/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND This meta-analysis aimed to compare conservative vs. operative treatment for humeral shaft fractures in terms of the nonunion rate, reintervention rate, permanent radial nerve palsy rate, and functional outcomes. Secondarily, effect estimates from observational studies were compared with estimates of randomized clinical trials (RCTs). METHODS The PubMed/Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for both RCTs and observational studies comparing conservative with operative treatment for humeral shaft fractures. RESULTS A total of 2 RCTs (150 patients) and 10 observational studies (1262 patients) were included. The pooled nonunion rate of all studies was higher in patients treated conservatively (15.3%) vs. operatively (6.4%) (risk difference, 8%; odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.5; I2 = 0%). The reintervention rate was also higher for conservative treatment (14.3%) than for operative treatment (8.9%) (risk difference, 6%; OR, 1.9; 95% CI, 1.1-3.5; I2 = 30%). The higher reintervention rate was predominantly attributable to the higher nonunion rate in patients treated conservatively. The permanent radial nerve palsy rate was equal in both groups (OR, 0.6; 95% CI, 0.2-1.9; I2 = 18%). There appeared to be no difference in mean time to union and mean Disabilities of the Arm, Shoulder and Hand scores between the treatment groups. No difference was found between effect estimates form observational studies and RCTs. CONCLUSION This systematic review shows that satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. No difference in mean time-to-union and short-term functional results was detected.
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Affiliation(s)
- Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Yassine Ochen
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Björn C Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, MA, USA
| | | | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijn R Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang D, Sun K, Jiang W. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures. J Int Med Res 2019; 48:300060519887264. [PMID: 31826692 PMCID: PMC7783250 DOI: 10.1177/0300060519887264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To conduct a meta-analysis to show the associations of perioperative and postoperative outcomes of mini-plate internal fixation (MPIF) versus Kirschner wire internal fixation (KWIF) for treating metacarpal and phalangeal fractures. METHODS A literature search was performed in PubMed, Web of Science, Cochrane Library, and Embase from the earliest date of data collection to April 2018. Studies that compared perioperative and postoperative outcomes of MPIF with those of KWIF in patients with metacarpal and phalangeal fractures were included. RESULTS Twenty-six articles met the inclusion and exclusion criteria (n = 2029 patients; 1042 with MPIF and 987 with KWIF). MPIF was related to a greater increase in length of surgery, hospital days, excellent and good rate of outcome, short-form health survey-36 score, and flexion and extension range compared with KWIF. MPIF was related to a greater decrease in intraoperative blood loss, finger visual analog scale score, functional exercise time, fracture healing time, incidence of complications, and postoperative infection rate compared with KWIF. CONCLUSIONS Patients with MPIF have sufficient pressure and strength, and MPIF promotes successful joint fusion and reduces complications of the operation. MPIF is ideal for reduction and stability of patients with metacarpal and phalangeal fractures.
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Affiliation(s)
- Dong Wang
- Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Kai Sun
- Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Wenxue Jiang
- Tianjin First Center Hospital, Nankai District, Tianjin, China
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Putnam JG, Nowak L, Sanders D, MacNevin M, Lawendy AR, Jones C, McKee M, Schemitsch E. Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures. Injury 2019; 50:1460-1463. [PMID: 31221428 DOI: 10.1016/j.injury.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures. PATIENTS AND METHODS Patients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005-2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex. RESULTS Plate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/-62 min vs. 102 +/-54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26-7.85). CONCLUSION Patients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures.
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Affiliation(s)
- Jill G Putnam
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States.
| | - Lauren Nowak
- University of Toronto, Toronto, Ontario, Canada.
| | - David Sanders
- London Health Sciences Centre, London, Ontario, Canada.
| | - Melanie MacNevin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States; London Health Sciences Centre, London, Ontario, Canada.
| | | | - Clifford Jones
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States.
| | - Michael McKee
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States.
| | - Emil Schemitsch
- London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada.
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Colombi R, Chauvet T, Labattut L, Viard B, Baulot E, Martz P. Is distal locking screw necessary for intramedullary nailing in the treatment of humeral shaft fractures? A comparative cohort study. INTERNATIONAL ORTHOPAEDICS 2018; 43:2151-2160. [PMID: 30171274 DOI: 10.1007/s00264-018-4091-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/02/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results. METHODS One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n = 74) or in group DI (with distal interlocking screw, n = 47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6 months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6 months of follow-up. Pain, operating time, and radiation time were also analyzed. RESULTS The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p = 0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09 ± 21.30 min vs DI 87.96 ± 30.11 min, p < 0.01) and fluoroscopy time (WDI 59.06 ± 30.30 s vs DI 100.36 ± 48.98 s, p < 0.01). CONCLUSIONS Thus, it seems that there were no significant differences between proximal unipolar and bipolar interlocking for humeral shaft fractures in terms of consolidation and clinical outcomes. WDI avoided the additional operating time and fluoroscopy time and risks linked to DI.
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Affiliation(s)
- Romain Colombi
- Orthopedic and Traumatology Department, Dijon University Hospital, F-21000, Dijon, France
| | - Thomas Chauvet
- Orthopedic and Traumatology Department, Dijon University Hospital, F-21000, Dijon, France
| | - Ludovic Labattut
- Orthopedic and Traumatology Department, Dijon University Hospital, F-21000, Dijon, France
| | - Brice Viard
- Orthopedic and Traumatology Department, Dijon University Hospital, F-21000, Dijon, France
| | - Emmanuel Baulot
- Orthopedic and Traumatology Department, Dijon University Hospital, F-21000, Dijon, France.,INSERM UMR1093-CAPS, Burgundy Franche-Comté university, F-21000, Dijon, France
| | - Pierre Martz
- Orthopedic and Traumatology Department, Dijon University Hospital, F-21000, Dijon, France. .,INSERM UMR1093-CAPS, Burgundy Franche-Comté university, F-21000, Dijon, France. .,Orthopedic and Traumatology Department, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France.
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12
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Basso M, Formica M, Cavagnaro L, Federici M, Lombardi M, Lanza F, Felli L. Unilateral external fixator in the treatment of humeral shaft fractures: results of a single center retrospective study. Musculoskelet Surg 2017; 101:237-242. [PMID: 28417290 DOI: 10.1007/s12306-017-0473-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of our work is to evaluate and critically analyze long-term clinical and radiological data of a new unilateral external fixator (MIKAI KIT FEP©-Mikai S.p.A, Genoa, Italy), in the treatment of humeral shaft fractures. MATERIALS AND METHODS We reviewed 47 patients affected by humeral fractures that underwent surgery from July 2010 to March 2016 with unilateral external fixator. Demographic characteristics of the patients were recorded, which included age, sex and baseline comorbidities and mechanism of injury. Surgical data such as time of surgery and time of fixation according to AO-type of fracture, clinical objective and subjective outcomes were collected. RESULTS The mean follow-up was 50.4 months (range 12-74). The patients' average age was 41.8 years (range 14-92). Mean surgical time was 66.8 (±37.7 min); and mean time of fixation was 4.5 (±1.7 months). We observed five delayed union (10.6%); one refracture (2.1%); and one case of non-union (2.1%) who underwent a revision surgery with nailing. No malunion was detected. Average quick-DASH was 11.7 (±14.8). The mean Constant Score at final follow-up was 81.5 (±14). 95.8% of patients were satisfied of our treatment. According to SF-12 scores, we observed 44 (93.6%) good results and 3 (6.4%) poor results. CONCLUSION We suggest the use of MIKAI KIT FEP© as a feasible option in the treatment of humeral shaft fractures. We reported optimal clinical and radiological outcomes at long-term follow-up. We advocate more powerful evidence to validate this new possible approach.
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Affiliation(s)
- M Basso
- Clinica Ortopedica, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy.
| | - M Formica
- Clinica Ortopedica, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - L Cavagnaro
- Clinica Ortopedica, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - M Federici
- Department of Orthopaedics and Trauma Surgery, Azienda Ospedaliera Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - M Lombardi
- Department of Orthopaedics and Trauma Surgery, Azienda Ospedaliera Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - F Lanza
- Department of Orthopaedics and Trauma Surgery, Azienda Ospedaliera Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - L Felli
- Clinica Ortopedica, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
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13
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Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van Rensburg L. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elbow Surg 2015; 24:210-4. [PMID: 25088479 DOI: 10.1016/j.jse.2014.05.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 04/17/2014] [Accepted: 05/04/2014] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to examine the union rate of humeral shaft fractures treated nonoperatively and to establish whether a particular fracture type is more likely to go on to nonunion. METHODS Radiographs and patient records of 207 humeral shaft fractures occurring during 5 years were retrospectively reviewed. All patients were initially managed nonoperatively and placed in a U-slab on diagnosis in the emergency department; this was converted to a functional humeral brace at 7 to 10 days after injury. Fracture location, morphology and comminution were assessed radiologically. Union was defined as the absence of pain and movement at the fracture site in the presence of radiographic callus formation. Nonunion was defined as no evidence of bone union by 1 year after injury or fractures requiring delayed fixation, defined as operative fixation undertaken more than 6 weeks after injury. RESULTS The study included 138 humeral shaft fracture patients; 18 patients (11%) were lost to follow-up, and 24 went on to nonunion, giving an overall union rate of 83%. Of the 24 nonunions, 15 underwent delayed operative fixation at an average of 8.3 months after injury. The union rate for proximal-third fractures was 76% compared with 88% for middle-third fractures and 85% for distal-third fractures. Comminuted fractures (defined as 3+ parts) had a 89% union rate regardless of position. CONCLUSION A lower threshold for surgical intervention may be considered in proximal-third, two-part spiral-oblique humeral shaft fractures. Brace therapy can be the optimal treatment regimen, but it is not the only option.
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Affiliation(s)
- Erden Ali
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK; Magdalene College, University of Cambridge, Cambridge, UK.
| | - Dylan Griffiths
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nnamdi Obi
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Graham Tytherleigh-Strong
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Lee Van Rensburg
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
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Xu J, Zhang C. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis. J Orthop Surg Res 2014; 9:24. [PMID: 24721182 PMCID: PMC3991881 DOI: 10.1186/1749-799x-9-24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
Objectives This meta-analysis aimed to compare the therapeutic effect of mini-plate versus Kirschner wire (K-wire) internal fixation on the treatment of metacarpal and phalangeal fractures among Chinese Han population. Methods Databases of China National Knowledge Infrastructure (CNKI), Wanfang, Chinese VIP, PubMed, and Embase were retrieved for studies on mini-plate (case group) versus K-wire (control group) internal fixation for the treatment of metacarpal and phalangeal fractures among Chinese Han population. The odds ratio (OR) and standardized mean difference (SMD) at 95% confidence interval (CI) were used for estimating the effects of dichotomous data and continuous data, respectively. All statistical analyses were performed by Review Manager 5.2 software. Results A total of 18 studies involving 1,375 metacarpal or phalangeal fracture patients (709 cases and 666 controls) were included in the meta-analysis. There were significant differences in fracture healing time (SMD = −1.28; 95% CI: −1.81, −0.76), postoperative infection rate (OR = 0.25; 95% CI: 0.16, 0.39), complication incidence (OR = 0.24; 95% CI: 0.15, 0.38), and surgery time (SMD = 1.57; 95% CI: 0.76, 2.37) between the case and the control group, while no significant difference was found in hospital stays between these two groups (SMD = 0.43; 95% CI: −0.34, 1.20; P = 0.27). Conclusions For the treatment of metacarpal or phalangeal fracture among Chinese Han population, mini-plate has advantages of shorter healing time and lower infection rate and complication incidence compared with K-wire internal fixation, while a longer surgery time than K-wire. In conclusion, mini-plate is prior than K-wire internal fixation for the treatment of metacarpal or phalangeal fracture among Chinese Han population.
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Affiliation(s)
| | - Changqing Zhang
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, Shanghai Province 200233, China.
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15
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Ayotunde OA, Sunday OK, Oluwatoyin A, Dare OJ. Results of surgical treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone grafting. ACTA ORTOPEDICA BRASILEIRA 2014; 20:223-5. [PMID: 24453607 PMCID: PMC3718407 DOI: 10.1590/s1413-78522012000400006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 10/24/2010] [Indexed: 11/22/2022]
Abstract
Objective We evaluated the treatment of nonunion of humeral shaft fracture with dynamic
compression plate from January 2002 to December 2009. Methods Twenty-two patients were treated over the study period. Trauma was the predominant
cause of injury in 86.4% of the patients. Results Nonunion was atrophic in 81.8% and hypertrophic in 18.2% of the individuals. There was
a primary injury of the radial nerve in 27.3% of the patients. All the participants had
closed fracture at presentation, and 81.2% had received previous treatment from
traditional bone setters and 18.8% had failure of the conservative cast management. The
average time to healing was 16 weeks. Previous treatment from traditional bone setters
significantly affected the time to fracture healing (p<0.05). All fractures had
successful union. Conclusion It was concluded that dynamic compression plating remains an effective treatment option
for nonunion of humeral shaft fracture. Level of Evidence III,
Retrospective study.
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16
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Hypertrophic Nonunion Humerus Mimicking an Enchondroma. Case Rep Orthop 2014; 2014:854349. [PMID: 25525539 PMCID: PMC4266758 DOI: 10.1155/2014/854349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face.
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17
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Young S, Lie SA, Hallan G, Zirkle LG, Engesæter LB, Havelin LI. Risk factors for infection after 46,113 intramedullary nail operations in low- and middle-income countries. World J Surg 2013; 37:349-55. [PMID: 23052810 PMCID: PMC3553402 DOI: 10.1007/s00268-012-1817-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The fields of surgery and trauma care have largely been neglected in the global health discussion. As a result the idea that surgery is not safe or cost effective in resource-limited settings has gone unchallenged. The SIGN Online Surgical Database (SOSD) is now one of the largest databases on trauma surgery in low- and middle-income countries (LMIC). We wished to examine infection rates and risk factors for infection after IM nail operations in LMIC using this data. METHODS The SOSD contained 46,722 IM nail surgeries in 58 different LMIC; 46,113 IM nail operations were included for analysis. RESULTS The overall follow-up rate was 23.1 %. The overall infection rate was 1.0 %, 0.7 % for humerus, 0.8 % for femur, and 1.5 % for tibia fractures. If only nails with registered follow-up (n = 10,684) were included in analyses, infection rates were 2.9 % for humerus, 3.2 % for femur, and 6.9 % for tibia fractures. Prophylactic antibiotics reduced the risk of infection by 29 %. Operations for non-union had a doubled risk of infection. Risk of infection was reduced with increasing income level of the country. CONCLUSIONS The overall infection rates were low, and well within acceptable levels, suggesting that it is safe to do IM nailing in low-income countries. The fact that operations for non-union have twice the risk of infection compared to primary fracture surgery further supports the use of IM nailing as the primary treatment for femur fractures in LMIC.
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Affiliation(s)
- Sven Young
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
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18
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Liu GY, Zhang CY, Wu HW. Comparison of initial nonoperative and operative management of radial nerve palsy associated with acute humeral shaft fractures. Orthopedics 2012; 35:702-8. [PMID: 22868596 DOI: 10.3928/01477447-20120725-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The optimal treatment approach for the initial management of radial nerve palsy associated with humeral shaft fractures has yet to be conclusively determined. The authors performed a systematic review of the literature to identify studies that compared the outcomes after initial nonoperative and operative management for radial nerve palsy associated with acute humeral shaft fractures. A meta-analysis of the data from these studies was also performed to determine whether recovery from radial nerve palsy was more favorable in one approach compared with the other. The primary outcome was recovery from radial nerve palsy and the secondary outcome was complaints after treatment. Nine articles (1 prospective observational and 8 retrospective) were included in the meta-analyses. Operative management showed no improved recovery from radial nerve palsy compared with nonoperative management. Nonoperative management was associated with a decreased risk of complaints relative to operative management. Recovery from radial nerve palsy associated with acute humeral shaft fractures is not influenced by the initial management approach.
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Affiliation(s)
- Geng-yan Liu
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, China
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19
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Abstract
Humeral shaft fractures account for approximately 3% of all fractures. Nonsurgical management of humeral shaft fractures with functional bracing gained popularity in the 1970s, and this method is arguably the standard of care for these fractures. Still, surgical management is indicated in certain situations, including polytraumatic injuries, open fractures, vascular injury, ipsilateral articular fractures, floating elbow injuries, and fractures that fail nonsurgical management. Surgical options include external fixation, open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and antegrade or retrograde intramedullary nailing. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. However, good surgical outcomes can be achieved with proper patient selection.
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20
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Gosler MW, Testroote M, Morrenhof JW, Janzing HMJ. Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database Syst Rev 2012; 1:CD008832. [PMID: 22258990 DOI: 10.1002/14651858.cd008832.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fractures of the shaft of the humerus account for 1% to 3% of all fractures in adults. The management of these fractures, including surgical intervention, varies widely. OBJECTIVES To assess and compare the effects of surgical versus non-surgical intervention for non-pathological fractures of the humeral shaft in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, trial registers, and bibliographies of trial reports. The full search was conducted in October 2011. SELECTION CRITERIA Considered for inclusion were all randomised and quasi-randomised (method of allocating participants to a treatment which is not strictly random; e.g. by date of birth, hospital record number or alternation) controlled trials that compared surgical with non-surgical intervention for humeral shaft fractures in adults. DATA COLLECTION AND ANALYSIS Two authors independently selected and assessed potential eligible studies for inclusion. MAIN RESULTS We found six completed studies that appeared to meet our inclusion criteria. After scrutiny, we excluded all six studies: five were retrospective studies and one was a prospective study without randomisation. We identified three potentially eligible ongoing studies, two of which involve randomisation of treatment allocation and one, which we excluded, that does not. AUTHORS' CONCLUSIONS There is no evidence available from randomised controlled trials to ascertain whether surgical intervention of humeral shaft fractures gives a better or worse outcome than no surgery. Sufficiently powered good quality multi-centre randomised controlled trials comparing surgical versus non-surgical interventions for treating humeral shaft fractures in adults are needed. It is likely that the results from the two ongoing randomised trials on this topic will help inform practice in due course.
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Affiliation(s)
- Maurits W Gosler
- Department of Surgery and Orthopaedic Surgery, Viecuri Medical Centre of Northern Limburg, Venlo,
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21
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Spontaneous healing of a pathologic fracture of the humerus. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e3182320426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Middendorp JJ, Kazacsay F, Lichtenhahn P, Renner N, Babst R, Melcher G. Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients. Eur J Trauma Emerg Surg 2011; 37:287-96. [PMID: 21837261 PMCID: PMC3150829 DOI: 10.1007/s00068-011-0099-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 03/03/2011] [Indexed: 01/29/2023]
Abstract
Background Although the non-operative management of closed humeral midshaft fractures has been advocated for years, the increasing popularity of operative intervention has left the optimal treatment choice unclear. Objective To compare the outcomes of operative and non-operative treatment of traumatic closed humeral midshaft fractures in adult patients. Methods A multicentre prospective comparative cohort study across 20 centres was conducted. Patients with AO type 12 A2, A3 and B2 fractures were treated with a functional brace or a retrograde-inserted unreamed humeral nail. Follow-up measurements were taken at 6, 12 and 52 weeks after the injury. The primary outcome was fracture healing after 1 year. Secondary outcomes included sub-items of the Constant score, general patient satisfaction, complications and cost-effectiveness parameters. Functions of the uninjured extremity were used as reference parameters. Intention-to-treat analysis was applied with the use of t-tests, Fisher’s exact tests, Mann–Whitney U-tests and adjusted analysis of variance (ANOVA). Results Forty-seven patients were included. The patient sample consisted of 23 women and 24 men, with a mean age of 52.7 years (range 17–86 years). Of the 47 cases, 14 were treated non-operatively and 33 operatively. The follow-up rate at 1 year was 81%. After 1 year, 11 fractures (100%) healed in the non-operative group and at least 24 fractures (≥89%) healed in the operative group [1 non-union patient (4%) and no data for 2 patients (7%)]. There were no significant differences in pain, range of motion (ROM) of the shoulder and elbow, and return to work after 6 weeks, 12 weeks and 1 year. Although operatively treated patients showed significantly greater shoulder abduction strength (p = 0.036), elbow flexion strength (p = 0.021), functional hand positioning (p = 0.008) and return to recreational activities (p = 0.043) after 6 weeks, no statistically significant differences existed in any outcome measure at the 1-year follow-up. Conclusions Our findings indicate that the non-operative management of humeral midshaft fractures can be expected to have similar functional outcomes and patient satisfaction at 1 year, despite an early benefit to operative treatment. If no radiological evidence of fracture healing exists in non-operatively treated patients during early follow-up, a switch to surgical treatment results in good functional outcomes and patient satisfaction.
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Affiliation(s)
- J. J. van Middendorp
- Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Trauma Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - F. Kazacsay
- Department of Traumatology, Borsod-Abaúj-Zemplén County Teaching Hospital, Miskolc, Hungary
| | - P. Lichtenhahn
- Department of Orthopaedics, Spital Schwyz, Schwyz, Switzerland
| | - N. Renner
- Department of Traumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - R. Babst
- Department of Traumatology, Kantonsspital Luzern, Luzern, Switzerland
| | - G. Melcher
- Department of Surgery, Spital Uster, Brunnenstrasse 42, 8610 Uster, Switzerland
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23
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Abstract
While intramedullary nailing has been established as the treatment of choice for diaphyseal fractures of the femur and tibia, its role in the management of diaphyseal humeral fractures remains controversial. The reasons include not only the complicated anatomy and unique biomechanical characteristics of the arm but also the fact that surgical technique and nail designs devised for the treatment of femoral and tibial fractures are being transposed to the humerus. As a result there is no consensus on many aspects of the humeral nailing procedure, e.g., the basic nail design, nail selection criteria, timing of the procedure, and the fundamental principles of the surgical technique (e.g., antegrade/retrograde, reamed/unreamed, and static/dynamic). These issues will be analyzed and discussed in the present article. Proposals aiming to improve outcomes include the categorization of humeral nails in two distinct groups: "fixed" and "bio", avoidance of reaming for the antegrade technique and utilization of "semi-reaming" for the retrograde technique, guidelines for reducing complications, setting the best "timing" for nailing and criteria for selecting the most appropriate surgical technique (antegrade or retrograde). Finally, suggestions are made on proper planning and conducting clinical and biomechanical studies regarding the use of intramedullary nailing in the management of humeral shaft fractures.
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Affiliation(s)
- Christos Garnavos
- Department of Orthopedics, Evangelismos General Hospital, Athens, Greece,Address for correspondence: Dr. C. Garnavos, 5, Poseidonos St., Glyfada 16674, Athens, Greece. E-mail:
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24
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Papasoulis E, Drosos GI, Ververidis AN, Verettas DA. Functional bracing of humeral shaft fractures. A review of clinical studies. Injury 2010; 41:e21-27. [PMID: 19523625 DOI: 10.1016/j.injury.2009.05.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/26/2009] [Accepted: 05/05/2009] [Indexed: 02/02/2023]
Abstract
Functional bracing has been widely accepted as the gold standard for treating humeral shaft fractures conservatively. We conducted a literature review to verify the efficacy of this treatment method. Sixteen case series and two comparative studies fulfilled the criteria set. Analysis of these clinical studies showed that humeral shaft fractures when treated with functional bracing heal in an average of 10.7 weeks. Union rate is high (94.5%). Statistical analysis showed that proximal third fractures and AO type A fractures have a higher non-union rate although this is not statistical significant. Residual deformity and joint stiffness are considered the main drawbacks of conservative treatment. Angulation--usually varus--rarely exceeded 10 degrees, while full shoulder and elbow motion was achieved in 80% and 85% of the patients, respectively. Nevertheless, in the few studies that subjective parameters such as functional scores, pain and quality of life were assessed results were not so promising.
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Affiliation(s)
- Efthimios Papasoulis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece.
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25
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Garnavos C, Lasanianos N, Kanakaris NK, Arnaoutoglou C, Papathanasopoulou V, Xenakis T. A new modular nail for the diaphyseal fractures of the humerus. Injury 2009; 40:604-10. [PMID: 19394611 DOI: 10.1016/j.injury.2009.01.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 02/02/2023]
Abstract
Over a period of 5 years, 63 traumatic and eight pathological diaphyseal humeral fractures were treated with a new modular humeral nail. The nail is cannulated, square in shape--with concave sides--and has two different extensions that can be used with either the antegrade or the retrograde approach. Adequate rotational and axial stability is provided without the need for distal locking screws in the majority of fractures, while the need for proximal locking screws during the antegrade procedure is abolished. This study aims to present the 'Garnavos' nail and the results of its use, along with proposals and guidelines that should be considered whenever intramedullary nailing is selected for the treatment of diaphyseal humeral fractures.
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Affiliation(s)
- Christos Garnavos
- Orthopaedic Department of Evangelismos General Hospital, 5 Poseidonos st., Glyfada 16674, Athens, Greece.
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Abstract
The conventional approach for antegrade intramedullary nailing (AIN) of humerus fractures is associated with persistent pain and compromised shoulder function. Damage to the critical hypovascular zone of the rotator cuff near its insertion on the humerus and/or irritation of the subacromial space by prominent hardware are the factors believed to be responsible for poor shoulder function after AIN of the humerus. This study describes a new entry portal through the rotator interval that minimizes iatrogenic damage to the rotator cuff at its insertion. This approach offers a solution for the disappointing postoperative shoulder function and pain scores associated with conventional antegrade nailing techniques. This study consisted of 33 patients with 34 humeral fractures followed for an average of 34 months. The overall satisfaction rate was more than 90%, according to the ASES (American Shoulder and Elbow Society) score. The mean Constant Score was 84 (SD, 14; range, 17 to 98), and primary bone union was achieved in 32 of the 34 cases.
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O'Donnell TMP, McKenna JV, Kenny P, Keogh P, O'Flanagan SJ. Concomitant injuries to the ipsilateral shoulder in patients with a fracture of the diaphysis of the humerus. ACTA ACUST UNITED AC 2008; 90:61-5. [PMID: 18160501 DOI: 10.1302/0301-620x.90b1.19215] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Antegrade intramedullary nailing of fractures of the shaft of the humerus is reported to cause impairment of the shoulder joint. We have reviewed 33 patients with such fractures to assess how many had injuries to the ipsilateral shoulder. All had an MR scan of the shoulder within 11 days of injury. The unaffected shoulder was also scanned as a control. There was evidence of abnormality in 21 of the shoulders (63.6%) on the injured side; ten had bursitis of the subacromial space, five evidence of a partial tear of the rotator cuff, one a complete rupture of the supraspinatus tendon, four inflammatory changes in the acromioclavicular joint and one a fracture of the coracoid process. These injuries may contribute to pain and dysfunction of the shoulder following treatment, and their presence indicates that antegrade nailing is only partly, if at all, responsible for these symptoms.
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Affiliation(s)
- T M P O'Donnell
- Department of Orthopaedics Connolly Memorial Hospital, Blanchardstown, Dublin 15, Ireland.
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Functional long-term outcome of the shoulder after antegrade intramedullary nailing in humeral diaphyseal fractures. ACTA ACUST UNITED AC 2008; 92:11-6. [DOI: 10.1007/s12306-008-0035-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 11/27/2007] [Indexed: 10/22/2022]
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Rosenberg N, Soudry M. Shoulder impairment following treatment of diaphysial fractures of humerus by functional brace. Arch Orthop Trauma Surg 2006; 126:437-40. [PMID: 16810551 DOI: 10.1007/s00402-006-0167-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. Since our previous clinical impression indicated an occurrence of shoulder function impairment following this treatment, we investigated the shoulder function in a consecutive series of patients treated by functional bracing for fractures of humeral shaft in order to estimate their residual shoulder function. MATERIALS AND METHODS We followed 15 consecutive patients with humeral shaft fractures treated by functional brace. The mean follow up was 30 months (range 12-57 months); seven patients with midshaft fracture, four patients with proximal third, and four patients with fractured distal third of the humeral diaphysis. All the patients were evaluated by the Constant score of the injured limb in comparison to the contra-lateral not injured shoulder and by the Oxford shoulder score of the injured limb. RESULTS We found that all the fractures were united with mean varus angulation of 13 degrees and with mean angulation in the saggital plane of 9 degrees antecurvatum, Constant scores were significantly lower in the injured shoulders (P < 0.001) and the function of the shoulders in the injured extremities were estimated as having mean Oxford shoulder score of 34 (range 17-54). CONCLUSIONS The evaluation of the present series revealed an impaired functional outcome in the shoulders after humeral shaft fracture. Our results indicate that although the fracture union is usually achieved following the functional bracing of humeral shaft fractures, the shoulder function in the injured limb may remain impaired.
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Affiliation(s)
- Nahum Rosenberg
- Orthopaedics A Department, Rambam Medical Center and The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, POB 9602, Haifa 31096, Israel.
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Fracturas diafisarias de húmero en mayores de 60 años: enclavado intramedular rígido. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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32
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Chao TC, Chou WY, Chung JC, Hsu CJ. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. INTERNATIONAL ORTHOPAEDICS 2005; 29:88-91. [PMID: 15714304 PMCID: PMC3474510 DOI: 10.1007/s00264-004-0620-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 10/11/2004] [Indexed: 01/29/2023]
Abstract
Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35-110) min; less mean blood loss, 70 (30-170) ml and shorter mean hospital stay, 5.8 (3-12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.
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Affiliation(s)
- Ting-Cheng Chao
- Orthopaedic Department, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung City, Taiwan
- Orthopaedic Section, Guo-Ren Hospital, Pingtung, Taiwan
| | - Wen-Ying Chou
- Department of Anesthesia, Chang-Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan
| | | | - Chien-Jen Hsu
- Orthopaedic Department, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung City, Taiwan
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
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Toivanen JAK, Nieminen J, Laine HJ, Honkonen SE, Järvinen MJ. Functional treatment of closed humeral shaft fractures. INTERNATIONAL ORTHOPAEDICS 2004; 29:10-3. [PMID: 15611875 PMCID: PMC3456948 DOI: 10.1007/s00264-004-0612-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 10/18/2004] [Indexed: 10/26/2022]
Abstract
We treated 93 consecutive patients, average age 53 (16-90) years, with closed humeral shaft fractures applying a functional brace immediately after injury. Seventy-two (77%) fractures healed without problems. There were significantly more consolidation problems in fractures in the proximal third (46% consolidated) compared to those at the middle (81% consolidated) and distal third (86% consolidated) of the shaft. Logistic regression analysis revealed the only predictive factor in respect to successful brace treatment was fracture location. No significant difference was found in respect to healing between different AO-type fractures.
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Affiliation(s)
- J A K Toivanen
- Division of Orthopaedics and Traumatology, Department of Surgery, Tampere University Hospital, PO Box 2000, 33521 Tampere, Finland.
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Flinkkilä T, Hyvönen P, Siira P, Hämäläinen M. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg 2004; 124:537-41. [PMID: 15338242 DOI: 10.1007/s00402-004-0727-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Antegrade intramedullary (IM) nailing of humeral shaft fractures is reported to cause shoulder joint impairment. This retrospective study compared shoulder joint symptoms, range of motion (ROM), and isometric strength after antegrade IM nailing and dynamic compression (DC) plating of humeral shaft fractures. MATERIALS AND METHODS We compared 29 patients with DC plating and 44 with antegrade IM nailing of their humeral shaft fractures. Shoulder pain, L'Insalata and Constant scores, shoulder joint ROM and isometric shoulder strengths were measured after mean follow-up of 6.2 (1-15) years (DC plating) and 5.5 (2-10) years (IM nailing). RESULTS Patients had nonsignificantly more shoulder pain after IM nailing than after DC plating. Shoulder scores and isometric strength measurements showed no difference between the groups. Flexion was significantly better after DC plating, but none of the other ROM parameters differed between the groups. The shoulder scores and all ROM and strength parameters of the injured side were significantly lower than on the uninjured side in both groups. CONCLUSIONS Shoulder joint ROM and strength does not recover to normal after humeral shaft fracture. Antegrade IM nailing if performed properly is not responsible for shoulder joint impairment.
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Affiliation(s)
- Tapio Flinkkilä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, University Hospital, Kajaanintie 52, 90220 Oulu, Finland.
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Petsatodes G, Karataglis D, Papadopoulos P, Christoforides J, Gigis J, Pournaras J. Antegrade interlocking nailing of humeral shaft fractures. J Orthop Sci 2004; 9:247-52. [PMID: 15168178 DOI: 10.1007/s00776-004-0780-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Accepted: 02/16/2004] [Indexed: 11/25/2022]
Abstract
The results of 39 humeral shaft fractures (37 patients) treated with antegrade locked nailing using a Russell-Taylor nail were reviewed. There were 30 acute fractures, 6 fractures malaligned in a hanging cast or brace, and 3 pathological fractures. Patient age ranged from 26 to 80 years (average, 59.7 years) and average follow-up was 25.7 months (range, 6-48 months). Fracture union was achieved in 92.3% of our cases, while shoulder function was excellent or good in 87.2% of cases. Antegrade locked nailing offers a dependable solution for the treatment of humeral shaft fractures, especially in polytrauma patients and cases of segmental or pathological fractures. Far less satisfactory results were obtained in comminuted fractures of the proximal third in the humerus, especially in osteoporotic patients, and we therefore advocate caution with the use of intramedullary nailing in this type of fracture. Certain technical aspects such as avoiding nailing the fracture in distraction, properly countersinking the tip of the nail, and achieving adequate fixation stability have been found to be of paramount importance to reduce the incidence of delayed union/non-union rate and to obtain better functional results from the shoulder joint.
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Affiliation(s)
- George Petsatodes
- 1st Orthopaedic Department, Aristotelian University of Thessaloniki, G. Papanikolaou General Hospital, 57010, Exohi, Thessaloniki, Greece
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Abstract
Twenty-seven male military recruits with humeral shaft fractures that occurred during throwing of a hand grenade were analyzed to determine the causes and contributing factors of this fracture in recreational pitchers. Average patient age was 22 years (range: 19-27 years). Objective criteria included type and fracture site on radiographs. Subjective data such as throwing style, previous pitching experience, and prodromal arm pain were obtained. The recruits' throwing style was deemed faulty. Analysis of the fracture configurations indicated an external rotation mechanism.
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Affiliation(s)
- Ozcan Pehlivan
- Department of Orthopedics and Traumatology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
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Lin J, Shen PW, Hou SM. Complications of locked nailing in humeral shaft fractures. THE JOURNAL OF TRAUMA 2003; 54:943-9. [PMID: 12777908 DOI: 10.1097/01.ta.0000032252.57947.47] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the complications of humeral locked nailing. METHODS Between 1994 and 2000, 161 humeral shaft fractures (98 acute fractures and 63 delayed unions or nonunions) in 159 patients treated with humeral locked nails were followed up for an average of 25.4 months. There were 89 men and 70 women, with an average age of 53.5 years. Acute fractures included 68 closed, 18 type I, 8 type II, 3 type IIIA, and 1 type IIIB open fractures. Thirty-six nonunions had previous operations. In general, acute fractures were treated with closed nailing and nonunions were treated with open nailing with bone grafting. Since 1998, interfragmentary wiring has been added in nonunions to compress the fracture. RESULTS In total, 30 patients had 31 significant complications. Nine of them were persistent nonunions, six from acute fractures and three from nonunions. Fracture gap was associated with a significantly higher risk of nonunion. The risk of operative comminution was significantly higher in retrograde nailing, and operative comminution resulted in a significantly higher risk of nonunion. Seven of the nine nonunions underwent revisional nailing and achieved eventual union. Removal of the protruded screws was performed in two cases. Other complications included shoulder impairment, elbow impairment, angular malunion, and post-nailing radial nerve palsy. CONCLUSION Many complications of humeral locked nailing can be prevented by improving the implant design or surgical techniques. The patients with persistent nonunion can be reliably treated by revisional nailing and bone grafting.
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Affiliation(s)
- Jinn Lin
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei
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38
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Intramedullary nailing for humeral shaft fractures: the misunderstood poor relative. ACTA ACUST UNITED AC 2001. [DOI: 10.1054/cuor.2001.0166] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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