ABSTRACT
But : Evaluer les résultats initiaux de nos des différents traitements des fractures ouvertes de l'humérus. Méthode: Il s'agissait d'une étude rétrospective réalisée à Abidjan (Côte d'Ivoire) sur une période de 10 ans, portant sur 16 fractures ouvertes de la diaphyse humérale. Elle incluait 10 hommes et six femmes d'âge moyen de 32,8 ans (Extrêmes : 21 et 61). L'ouverture cutanée était classée selon Cauchoix et Duparc. Les fractures étaient, soit traitées par parage suivi de plâtre brachio-anti-brachial, soit traitées par plaque vissée ou fixateur externe. Les patients étaient suivis selon un protocole strict. Les résultats globaux étaient évalués par la cotation fonctionnelle de Stewart et Hundley. Résultats : Au recul minimum de 24 mois, tous les patients avaient consolidé. On notait un cas d'infection locale, trois cas de raideur du coude et quatre cas réversibles de paralysie du nerf radial. Les résultats fonctionnels selon le score de Stewart et Hundley étaient très bons dans 11 cas, bons dans quatre cas et assez-bon dans un cas, et aucun mauvais résultat. Conclusion : En fonction des indications thérapeutiques, les résultats initiaux sont satisfaisants tant sur le plan clinique que fonctionnel.
Aim: To evaluate the initial results of our different treatments of open humeral shaft fractures. Method: This was a retrospective study conductecd in Abidjan (Ivory Coast) over a period of 10 years, involving 16 open humeral shaft fractures. It included 10 men and six women with a mean age of 32.8 years (Extremes: 21 and 61). The skin opening was classified according to Cauchoix and Duparc. Fractures were either treated by trimming followed by a brachial-ante-brachial cast, or treated with a screwed plate or external fixator. Patients were followed according to a strict protocol. Overall results were assessed by Stewart and hundley functional scoring. Results: At a minimum follow-up of 24 months, all patients had consolidated. There was one case of local infection, three cases of elbow stiffness and four reversible cases of radial nerve palsy. The functional results according to the Stewart and Hundley score were very good in 11 cases, good in four cases and fair in one case, with no poor result. Conclusion: Depending on the therapeutic indications, the initial results are satisfactory both clinically and functionally.
Subject(s)
Humans , Male , Female , Treatment Outcome , Adult , Fractures, OpenABSTRACT
@#Introduction: Controversies exist in treatment of proximal humerus fractures as treatment options vary greatly from conservative management, closed pinning, stacked intramedullary nails, plating and hemi-arthroplasty. The purpose of this study is to study the fracture patterns of each case and document the functional outcome and complications post-operative in the management of proximal humerus fractures operated with proximal humerus plate. Materials and Methods: Thirty five patients with closed proximal humerus fractures, above 18 years old, admitted in our tertiary care hospital during the study period were enrolled. Patients underwent open reduction internal fixation with proximal humerus locking plate under general anaesthesia. Post-operative patients were assessed using Constant and DASH scores. Complications were recorded. Results: In our study the absolute Constant score of the study population increases at three months and six months and was found to be significant. Mean Constant score for 4- part fractures was 45.6 which were inferior as compared to 2-part and 3-part fractures (43.1 and 44.6, respectively). The mean Constant score at six months was 51.80 +/- 6.71. All three types of proximal humerus fractures showed significant improvement in the mean DASH score over our study period of six months and was found to be significant. Mean DASH score at six months was 27.97+/-12.84. Out of the 35 cases in the study two had complications. One had implant failure (Neer’s type 3, 60-year-old female) and one had varus collapse (Neer’s type 3, 45-year-old male). Conclusion: Due to angular stability and effective maintenance of the intraoperative fracture reduction during follow-up period, early post-operative mobilisation is possible which helps the patient to attain better shoulder range of motion and return to activity faster.
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Background: Fractures of the humeral shaft are commonly encountered in the emergency department and are treated conservatively or surgically. Quantification of the results forms an important part of the treatment protocol and scoring systems are one of the best ways for quantification without bias. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a questionnaire which is filled by the patient and is used to assess the results in the upper limb. Methods: Between October 2004 and December 2008, 68 patients with fracture of the shaft of the humerus were managed surgically in our institutions. Four were lost to follow up and the remaining 64 were assessed clinico-radiologically and by the DASH questionnaire. The results given by the two methods of assessment were then compared. Results: There were 30 excellent, 18 good, 11 fair and 5 poor results when assessed clinically and radiologically. There were 32 excellent, 18 good, 9 fair and 5 poor results when the same patients were assessed by the DASH questionnaire. Conclusion: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is an efficient instrument to quantify the results in fractures of the humerus.
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Background: Supracondylar fractures of humerus is the commonest injury, constitutes about 65.4% of all fractures about the elbow in children. Displaced supracondylar fracture of humerus demand great respect and challenging one to treat, since it requires accurate anatomical reduction and internal fixation to prevent complications. So, in this study, we reported the results of open reduction and internal fixation with K-wires in the displaced (Gartland’s type III) supracondylar fracture humerus in children. Material and Methods: Thirty cases of displaced (Gartland’s type III) supracondylar fractures treated by open reduction and internal fixation with K-wires were studied between September 2011 to August 2013 at our institution and followed for an average of 24 months. Results: We came across 36 male patients and 14 female patients. Majority of the cases (38) were due to high energy trauma of road traffic accidents involving relatively younger patients. At the end of 5 months, all except four patients could mobilize independently without any aid. We did not come across complications like fracture of femur and failure of fixation and no reoperations were required. Conclusions: Open reduction and internal fixation with K-wires is the most commonly accepted treatment of displaced supracondylar fracture humerus in children when done at appropriate time. It gives more stable fixation, better anatomical reduction with negligible complication.
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Introduction: This paper presents evaluation of 103 patients of diaphyseal fractures of humerus treated by different modalities with a mean follow-up of two years. Material and methods: This is a prospective and retrospective study conducted at Dr Rajendra Prasad Govt. Medical College and Hospital, Kangra (Tanda), HP, India during the year 2005-2006. It aimed at finding out comparison of the results obtained by different modes of treatment in fractures of humeral diaphysis. We studied a total of 103 patients out of which a prospective study involved 72 patients and a retrospective study (2003-2004) involved 31 patients (whose records were available). All the cases were examined clinically and radiologically and were managed with an appropriate method of treatment. The closed fractures were classified by Muller’s classification while Gustillo Anderson was used for open fractures. The nonoperative methods included cooptation or U-shaped brachial splint or U-slab, hanging arm cast, Velpeau dressing, Shoulder spica cast and functional brace. The patients with failure of closed reduction, with complex fracture geometry or open fractures were treated by operative methods. The patients were followed up weekly for the first three weeks and than at six weekly intervals to a maximum of two years (range 16-26 months) or till the union was achieved. From the prospective study, three patients were lost to follow-up and hence excluded from the study. Functional outcome was assessed by Modified Stewart and Hundley (1955) criteria. Results: Out of 100 patients there were (44 A fractures [A1-13, A2-9, A3-22], 36 B fracture [B1-26, B2-9, B3-1] and 20 C fractures [C1-15, C2-4, C3-1]). Out of these 14 fractures were associated with open injury (2 Grade I , 4 Grade II, 4 Grade IIIa, 3 Grade IIIb, 1 Grade IIIc). Forty-six cases treated conservatively united at 24 weeks (15.65 weeks) and 54 patients, which were treated by different modalities united at 36 weeks (Ex-fixator), 22 weeks (Nail), 20.3 weeks (Plate and screws). Good results were obtained in 100% by Velpeau dressing in children, 85% by U-slab, 50% by plate and screws and 33.3% with nailing. There were postoperative complications like infection (6%), radial nerve palsy (2%) and nondelayed union (5-6%). Conclusion: Conservative management is method of choice in management of closed diaphyseal fractures of humerus as it gives early union, better limb function and is devoid of any of the routine postoperative complications. Patients with failed conservative treatment, open fractures and fractures with complex geometry are better managed operatively. ORIF with plate and screws has proven to be better than nailing procedures in present series in terms of giving better functional outcome. Patients treated with external fixator had mostly fair and poor outcome as injuries dealt by them were open type III injuries.
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A new /different method of pinning of the displaced extension type supracondylar fractures of the humerus in children is presented. Here two pairs of K wires are used. The fracture is reduced under C- arm image intensifier control and then two K wires are passed through lateral epicondyle and holding the reduction two more wires are passed from the lateral supra-condylar ridge obliquely downwards and inwards across the fracture site into the medial epicondyle. Thirty cases, thus treated, are presented here. Mean follow up for 26 cases was 28 months. Four cases were lost to follow up .At the final follow up ,using Flynn's overall modified classification, the clinical result was considered to be excellent in 19 (73%) patients, good in 5 (19.23%) and poor in 2 (7.69%) patients. The protocol described here resulted in good to excellent results in 24/26 cases (92.30%) thus proving its usefulness in displaced extension type supracondylar fractures in children.
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Four-part displaced fractures, four-part fracture-dislocations, impression fractures of the articular surface involving greater than 50% of the head, and head-splitting fractures are to be best treated by primary prosthetic replacement. 3 primary prosthetic replacements were performed for the treatment of the proximal humeral fractures(l case of four-part displaced fracture, 2 cases of fracture-dislocation) and all cases were followe( up at least 3 years. Case II had excellent result, case I was satisfactory, and case III failure by Neers numerical ratin method. There were proximal subluxation roentgenologically in case I and III.