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INTRODUCTION@#This study compared Polyvinyl Chloride (PVC) made vs Plaster of Paris (POP) made functional braces in the closed treatment of fractures of the humeral shaft. Outcomes examined were the rate of fracture union, radiographic alignment, DASH scores and the range of motion of the shoulder and elbow@*METHODS@#This was a parallel randomized clinical trial conducted at the Corazon Locsin-Montelibano Memorial Regional Hospital from July 2016 to July 2017. All eligible patients were included and randomly allocated into PVC and POP treatment groups. All patients were followed-up on the 3rd, 6th, 10th, and 14th week for clinical and radiographic evaluation.@*RESULTS@#There were 31 patients, 14 and 17 in the PVC and POP groups, respectively. The median rate of union in the PVC and POP groups were 10.50 and 10.00 weeks, respectively. The median varus and valgus angulation in the PVC and POP groups were 15.75° and 16.5°, respectively. The median anterior and posterior alignment in the PVC group was 1.7° and POP group was 9.6°. The median DASH score of the PVC and POP groups were 7.1 and 12.5, respectively. The median range of motion in the elbow was 135° for both groups. The median range of motion in the shoulder in the PVC group was 150° and POP group was 140°.@*CONCLUSION@#There was a high rate of union of humeral shaft fractures with acceptable functional outcome with the use of the PVC made functional brace compared to the traditional POP made functional brace.
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Objective To compare the efficacy and safety between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in the treatment of humeral shaft fracture.Methods Case-control studies and randomized clinical trials comparing MIPO with ORIF in the treatment of humeral shaft fracture from January 2010 to June 2018 were retrieved from PubMed Library,Cochrane Library,Embase Library,China National Knowledge Internet and Wanfang Data.Methodological quality of the studies and trials was critically assessed.REVMANS.3 was used for data analysis.The 2 groups of patients were compared in terms of University of California,Los Angeles shoulder rating scale (UCLA),Mayo Elbow Performance Score (MEPS),union time,nonunion rate and complications.Results A total of 452 patients from 9 articles were included.There were 216 cases in the MIPO group and 236 ones in the ORIF group.The Meta analyses showed that the MIPO group had a significantly higher UCLA score (WMD =0.36,P=0.03),significantly lower incidences of complications (OR =-0.15,P ＜ 0.05) and iatrogenie radial nerve palsy (OR =0.24,P ＜ 0.05),and significantly shorter union time (SMD =-0.36,P =0.02) than the ORIF group.There were no significant differences between the 2 groups in MEPS (WMD =-0.48,P =0.43) or nonunion rate (OR =0.45,P =0.11).Conclusion MIPO may be a better choice for humeral shaft fracture than ORIF in regards to postoperative shoulder functions,union time,and incidences of complications and iatrogenic radial nerve palsy.
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BACKGROUND: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. METHODS: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. RESULTS: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). CONCLUSIONS: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.
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Humans , Accidental Falls , Accidents, Traffic , Classification , Contusions , Follow-Up Studies , Fracture Fixation, Intramedullary , ShoulderABSTRACT
<p><b>OBJECTIVE</b>To observe the clinical effects of closed reduction and percutaneous double K-wires internal fixation in treating multisegmental fracture of humeral shaft.</p><p><b>METHODS</b>From January 2009 to April 2015, 27 patients with multisegmental fracture of humeral shaft were treated with closed reduction and percutaneous double K-wires internal fixation, including 10 males and 17 females, ranging in age from 26 to 81 years with an average of 52 years;the disease course ranged from 2 hours to 6 days with an average of 1.5 days. Operative time, intraoperative blood loss, hospital stay, fracture healed time, complications were observed and recovery of shoulder joint function was evaluated by Constant-Murley shoulder score.</p><p><b>RESULTS</b>All the patients were followed up from 12 to 24 weeks with an average of 16 weeks. Operative time was 20 to 40 min with an average of 28 min; intraoperative blood loss was 5 to 25 ml with an average of 10 ml;hospital stay was 3 to 5 days with an average of 3.5 days. All fractures got bone healing and healed time was 12 to 22 weeks with average of 14 weeks. Postoperatively 1 case complicated with wire tail bulging and local irritation symptoms, and the symptoms disappeared when the wire was removed out after the fracture healing; 1 case complicated with local infection after wire tail disengaging, and recovered through anti-septic treatment. According to the Constant-Murley standard of shoulder joint function, 10 cases got excellent results, 15 good, 2 fair, with scores of 89.1±2.7.</p><p><b>CONCLUSIONS</b>Closed reduction and percutaneous double K-wires fixation for the treatment of multisegmental fractures of humeral shaft have advantages of simpler manipulating, less bleeding, less invasive, less complications, and shoulder and elbow joint can obtain good recovery. But closed reduction and percutaneous double K-wires internal fixation cannot be effective against rotation and provide axial stability, the immoblization with a sling or other auxiliary methods should be applied.</p>
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Objective:To compare the difference between non-operative and operative treatment of humeral shaft fractures.Methods:From March 2005 to October 2012,252 cases of humeral shaft fractures were treated and were adequately followed up.According to the treatment methods,the patients were divided into 2 groups:the non-operative group and the operative group.In the non-operative group,there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with inter nal fixation either by plating or by nailing in the operative group.The follow-up parameters included:fracture healing rate,fracture union time,complications rate,Constant-Murley shoulder score and Mayo elbow score.Results:The mean follow-up period was (31.24 ± 20.06) months (ranging 6 to 103 months).There were no statistical differences in age,open fracture number,fracture site and Arbeitsgemeinschaft ftir Osteosynthesefragen (AO) classification between the non-operative group and the operative group.The fracture healing rate:the non-operative group:96.1％ (72/76),the operative group:97.7％ (172/176),P =0.46;the fracture union time:the non-operative group:(10.24 ± 2.93) weeks,the operative group:(10.69 ± 2.51) weeks,P =0.22;the complication rate:the non-operative group:5.3％ (4/76),the operative group:15.3％ (27/176),P =0.03.The complications included:nonunion:the non-operative group:3.95％ (3/76),the operative group:2.3％ (4/176),P =0.434;radial nerve palsies:the non-operative group:0％ (0/76),the operative group:5.7％ (10/176),P =0.035;bone split:the non-operative group:0％ (0/76),the operative group:1.7％ (3/176),P =0.556;elbow stiffness:the non-operative group:l.3％ (1/76),the operative group:0.6％ (1/176),P =1.000;shoulder pain:the non-operative group:0％ (0/76),the operative group:5.1％ (9/176),P =0.061.The Constant-Murley shoulder score:the non-operative group:97.37±4.94,the operative group:96.34 ± 6.88,P =0.244.The Mayo elbow score:the non-operative group:99.80 ± 1.72,the operative group:99.49 ± 2.73,P =0.923.Conclusion:The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.
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Objective To analyze the effect of calcitonin combined with alfacalcidol on clinical outcome,lumbar vertebrae bone mineral density and safety in patients undergoing internal fixation of humeral shaft fracture.Methods 80 patients with humeral shaft fracture treated with internal fixation in Xunwu county people's hospital from June 2010 to June 2016 were selected,and randomly divided into control group and observation group,40 cases in each groups.The control group was given calcium carbonate D3 tablets and functional exercise therapy,the observation group treated calcitonin combined with alfacalcidol on the basis of control group,analysis and comparison the clinical effects,lumbar spine BMD and safety.Results Compared with before treatment,serum calcium level of two groups increased significantly at treatment 2 weeks and 3 weeks(P<0.05);The control group BMD of lumbar spine was significantly increased in treatment 12 weeks(P<0.05),the observation group BMD of lumbar spine was significantly increased in treatment 4 weeks and 12 weeks(P<0.05).Compared with control group,the level of serum calcium in observation group was higher at treatment 2 weeks and 3 weeks (P<0.05),BMD of lumbar spine was higher at treatment 4 weeks and 12 weeks(P<0.05);The total adverse reaction rate of observation group was 10%,the difference was not statistically significant to control group 15%.Conclusion The combination of calcitonin and alfacalcidol treatment of internal fixation of humeral shaft fractures in patients with significant results, can improve serum calcium levels in patients with and improve bone mineral density, and less adverse reactions.
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Objective To evaluate the clinical effects of open reduction plate screw nail internal fixed and minimally invasive elastic intramedullary nail internal fixation combined with neck strap suspension for treating adult humeral shaft fracture . Methods A retrospective analysis was made on the clinical data of 65 patients with humeral shaft fracture in our hospital from March 2012 to March 2014 ,including 38 cases of open reduction plate screw internal fixation (plate screw nail fixation group) and 27 cases of limited open or closed reduction elastic intramedullary nail internal fixation combined with neck strap suspension (elastic intramedullary nail group) .The operation time ,intraoperative blood loss amount ,iatrogenic radial nerve injury ,occurrence rate of incision infection ,postoperative fracture reduction degree ,fracture recovery time and elbow joint function score were compared be‐tween the two groups .Results The operation time and intraoperative bleeding volume in the elastic intramedullary nail group were less than those in the plate screw nail fixation group ,the differences were statistically significant (P0 .05) ,the postoperative shoulder and elbow joint function scores in the plate screw nail group were significantly higher than those in the elastic intramedullary nail group ,the difference was statistically significant (P<0 .05) .No serious nerve damage ,incision infection and other postoperative complications occurred in the two groups .Conclusion Both the open reduction plate screw nail internal fixation and elastic intramedullary nail in‐ternal fixation are effective method for treating adult humeral shaft fracture ,the latter has shorter operation time ,less intraoperative bleeding ,but shoulder elbow pain and limitation of motion are more serious than the former .
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Objective To compare biomechanical properties of the helical and straight long PHILOS (proximal humerus internal locking system) plates (Synthes Inc., Switzerland), so as to provide some biomechanical evidence for treating proximal metaphyseal-diaphyseal humeral shaft fractures in clinic. Methods Twelve Synbone artificial bones of right humerus (SYNBONE Inc., Switzerland) were divided into two groups. In control group (n=6), the humerus was fixed with the 10 hole long straight PHILOS plate, while in experimental group (n=6), the humerus was fixed with the same long PHILOS plate which was precontoured for moulding (i.e. helical PHILOS plate). After the proximal metaphyseal-diaphyseal humeral shaft fractures were made in all artificial bones, the biomechanical properties of the specimens in two groups under 6 loading modes (i.e., axial tension and compression, torsion in the same and reverse direction, medial-lateral and anterior-posterior three-point bending) were tested en bloc and compared. ResultsCompare with control group, under 100-500 N tensile and compressive loads, the axial displacement at the fractured end in experimental group increased by about 95% and 58%, respectively. Under 0.6-3 N•m torsional moment in reversed direction, the tensional angle in experimental group was obviously smaller than that in control group, with a decrease of 55%-64%. Under medial-lateral bending moment of 1.5 and 3 N•m, no significant difference was found in deflection of the experiment and control group, while under medial-lateral bending moment of 4.5, 6 and 7.5 N•m, the deflection in experimental group decreased by 20%-30% as compared to control group. Under 0.6-3 N•m torsional moment in the same direction and 1.5-7.5 N•m anterior-posterior bending moment, both the torsional angle and the deflection in experimental group were larger than those in control group, with a significant difference (P＜0.05). Compared with control group, the tensile stiffness and compressive stiffness decreased by 49% and 36%, the torsional stiffness in the same direction decreased by 19% and that in reversed direction increased by 150%, three-point bending stiffness in medial lateral direction increased by 18% and that in anterior posterior direction decreased by 70% in experimental group, all with a significant difference (P＜0.05). ConclusionsCompared with the long straight PHILO plate, the long helical PHILOS plate has better biomechanical properties, which can meet the clinical need of proximal metaphyseal-diaphyseal humeral shaft fracture fixation and postoperative rehabilitation. This surgical technique is expected to be widely applied in clinic, especially with the advantage of minimal invasive surgery.
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BACKGROUND: Studies comparing the relative strength of polymethylmethacrylate (PMMA) augmented fixation, standard plating and locked compression plate (LCP) system are few. The use of either the bone cement-augmented dynamic compression plate or the Hybrid LCP constructs may provide an additional tool for the treatment of fractures in patients with osteoporosis. METHODS: Eighteen (18) osteoporotic cadaveric humeral bones were assigned randomly to each of three groups (Dynamic Compression Plate [DCP], DCP augmented with bone cement, and the Hybrid LCP system) and tested in anterior-posterior bending and torsion/external rotation. The load to failure values were obtained and the results for each specimen compared. RESULTS: Significant differences were observed between the standard DCP and Hybrid LCP group (p-value=0.012), and in the cement-augmented and Hybrid LCP group (p-value=0.099) in torsion/external rotation loading. No significant difference was observed between the standard DCP and bone-cement augmented group (p-value=0.248). No significant difference was observed among the three groups in terms of stiffness (p-value=0.3868) in the four-point anterior-posterior bending modality. Screw pull-out of the implant was observed only in the regular DCP group in torsion/external rotation loading stress. CONCLUSION: Significant differences were seen between the three constructs in torsion/external rotation but not in anterior-posterior four-point bending. Bone failure, but not screw pull-out, was seen in the Hybrid LCP and bone cement-augmented DCP groups in torsion. This study showed that the LCP system and the bone cement-augmented constructs may provide greater screw purchase to the osteoporotic humerus.
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Humans , Humans , Bone Cements , Bone Screws , Polymethyl Methacrylate , Rotation , Bone Plates , Fracture Fixation, Internal , Fractures, Bone , Osteoporosis , HumerusABSTRACT
PURPOSE: We evaluated the efficacy and results of minimally invasive anterior plating for humeral shaft fracture. MATERIALS AND METHODS: Twenty-two cases of humeral shaft fracture were reviewed, including 8 cases of type A, 8 of type B and 6 of type C (AO/OTA classification). There were three open fractures. The fracture was fixed with MIPO (minimally invasive plate osteosynthesis) technique under C-arm guide. A locking compression plate was located in anterior aspect of the humerus with at least three screws fixed in each fragment. Radiologic and functional results were evaluated. RESULTS: In 20 of 22 cases, bony union was achieved with the mean period of 17.5 weeks, including 2 cases of delayed union. There were 2 cases of nonunion, which needed the further operative procedure. Except one case of distal 1/3 fracture, all cases showed satisfactory elbow and shoulder function with the mean Mayo elbow score of 17.4 and mean UCLA shoulder score of 97.3. In complication, there was one case of radial nerve palsy due to improper traction, but it was completely improved after 3 months. Otherwise, there was no complication including infection. CONCLUSION: Anterior MIPO for humeral shaft fracture may be another option of operative methods with high union and low complication rate.
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Elbow , Fractures, Open , Humerus , Paralysis , Radial Nerve , Shoulder , Surgical Procedures, Operative , TractionABSTRACT
Dislocation of the shoulder with ipsilateral humeral shaft fracture is very rare, but serious injury that requires emergent care. There have been approximately 20 cases reported in the English literature, but it has never been reported in Korea. We report a case of dislocation of right shoulder with ipsilateral humeral shaft fracture which was successfully treated by closed reduction of the shoulder under general anesthesia and internal fixation with antegrade interlocking intramedullary nailing for the humeral shaft fracture.
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Anesthesia, General , Joint Dislocations , Fracture Fixation, Intramedullary , Korea , Shoulder , Shoulder DislocationABSTRACT
An injury to the brachial artery from humeral shaft fracture is uncommon but requires immediate surgery to restore the blood flow. We report a case of endovascular stenting to repair a brachial artery occlusion caused by humeral shaft fracture in a 53 year old male with a review of the relevant literature.
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Humans , Male , Brachial Artery , StentsABSTRACT
Objective Investigate the diagnosis and treatment of 9 cases in humeral shaft fracture combined with brachial artery injury. Methods 9 cases of humeral shaft fracture combined with brachial artery injury were treated. Results 1 patient was carried out amputation because severe soft tissue injury, obvious limb swelling after operation and occurring thrombosis. The muscles of 2 cases was ischemic and contracture, functional poor because of visiting late. The remaining 6 cases as a result of the diagnosis and treatment in a timely manner, postoperative function were satisfactory. Conclusion Timely diagnosis and treatment for patiends of humeral shaft fracture combined with brachial artery injury can have the good clinical results.
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Presentamos el caso de un paciente masculino de 53 años de edad que luego de recibir un trauma en el hombro izquierdo, acude a nuestro Servicio, con dolor intenso, deformidad e incapacidad funcional absoluta de ese miembro. Se diagnostica una luxación glenohumeral posterior, asociada a fractura diafisaria de húmero. Se realiza reducción cerrada de la luxación y fijación interna con lámina AO de la fractura diafisaria. Luego de la reducción, los estudios imagenológicos mostraron una fractura del aspecto anterointerno de la cabeza humeral (lesión de Mc Laughlin) y fractura del reborde glenoideo posterior (lesión de Bankart invertida). Se mantiene tratamiento conservador a pesar de la magnitud del daño articular y se obtienen resultados funcionales satisfactorios. Se discuten además las posibles opciones de tratamiento.
We report a case of a 53 years old male who received a trauma in his left shoulder. He came to our Service whit intensive pain, deformity and absolute funcional incapacity in his left upper limb. We diagnose a posterior glenohumeral dislocation associated to an humeral shaft fracture. A closed reduction for the dislocation and an open internal fixation whit ASIF plate for the shaft fracture were performed. Before the reduction of the dislocation image study showed a fracture on the postero-internal side of the humeral head (Mc Laughlin lesion) and a fracture on the posterior glenoid rim (reversed Bankart lesion). We maintained non surgical treatment for the dislocation and we obtained funcional satisfactory result. We discussed beside, others possible options of treatment.
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Humeral fracture during arm wrestling is unusual. There are not many cases described. Demographical characteristics and mechanism seems to be a common factor. Frequently, correspond to a distal third humeral shaft spiral fracture. Some cases can be associated to a radial nerve injury. We present 2 cases which shown similar fractures, one of them with radial nerve palsy. Both cases underwent to open reduction and internal fixation.
La fractura de húmero por medición de fuerzas o gallitos, es un evento inusual. Los reportes bibliográficos son escasos. Las características demográficas y el mecanismo parecieran ser un factor común en todos los casos. Generalmente, corresponde a una fractura de tercio distal de diáfisis humeral de rasgo espiroideo. En algunas ocasiones se puede asociar a compromiso del nervio radial. Mostramos2 casos, los cuales presentan fracturas de similares características y uno de ellos compromiso del nervio radial. La resolución de ambos casos fue quirúrgica.
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Humans , Male , Adult , Humeral Fractures/surgery , Humeral Fractures/etiology , Wrestling/injuries , Fracture Fixation, Internal , Humeral FracturesABSTRACT
[Objective] To evaluate the clinical efficacy of treatment of humeral shaft fracture with revolving intramedullary nails.[Method]Sixty-two cases with fracture of hume ral shaft were treated by revolving intramedullary nails between January 2000 and February 2006.Their were 38 male cases and 24 female cases.Their average age was 36.9(ranged 20～58).Fifty-fous cases were closed fractures,and eight cases were opened.Sixty-two cases with fracture of humeral shaft according to AO classification,41 cases were type A,15 cases were type B,6 cases were type C.Sixty-two patients with the humeral shaft fracture were treated with limited open reduction and minimally invasive internal fixation with revolving intramedullary nails.Scientific and rational rehabilitative treatment was carried out in each case after the operation.All patients were follow-up between 14 months and 30 months.The average follow-up period was 24 months.[Result]The fracture union occurred in sixty-two patients.The average healing time was 15 weeks.According to Rodriquez-Merchang shoulder functional score system,the excellent result was achieved in 36 patients,good in 20 and fair in 6.The excellent and good rate was 90.3%.All cases got good function recovery.The effects were satisfactory.There were no complications in all cases,such as infection,iatrogenic fracture,shortening,break of nail,fat embolism syndrome and peripheral nerve injury.[Conclusion]Revolving intramedullary nails for treatment of humeral shaft fracture is effective with litter interference with the blood supply of the bone fracture and with stable immobilization.Due to the abutment of the longitudinal bars along the entire length of the medullary canal wall,highly resistant to the rotational strength was achieved.The advances of revolving intramedullary nails are convenient in operative procedure with little invasive of operation,early function exercise,high raito of fracture healing and safety compared with the normal operative therapy.The operation indication and timing should be controlled strictly.The manipulation should be familiar.This kind of treatment is worth to be recommended.
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65 years,Type A in 1,Type B in 1).Radial nerve injury resulted from operation obtained complete recovery 3 months post-operation;1 case that transient ulnar nerve palsy recovered 3 days after operation;elbow heterotopic ossification in 1 case;there were no radial nerve injury in 23 cases where the plate was removed in same approach.Elbow function evaluated by Mayo Score system were excellent in 18,good in 8,fair in 4,bad in 3.At the last follow-up,the strength of triceps was about 4～5 grade.[Conclusion]The fracture of middle and lower humeral shaft can be exposed and fixed safely by triceps-splitting approach,the rate of complications was acceptable.
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PURPOSE: To compare the results and complications of interlocking IM nailing and plate fixation by posterior approach in the treatment of traumatic humeral shaft fracture MATERIALS AND METHODS: From March 1997 to March 2003, 49 patients undergone operation due to traumatic humeral shaft fracture. Follow-up was over one year. 28 patients operated with interlocking IM nailing initially and 21 operated with plate fixation by posterior approach prospectively. Statistics were compared using clinical and radiological outcomes and complications. RESULTS: Radiologically, bone union was observed after an average of 14.3 weeks in IM nailing, and 11.7 weeks in plate fixation. So plate fixation showed earlier bone union (p=0.012). Nonunion occurred in 4 cases (14.3%) operated with IM nailing, and 1 case (4.8%), that was open shaft fracture, with plate fixation. Nonunion occurred more frequently when operated by IM nailing. 6 cases showed limitation of shoulder movement due to damage of the rotator cuff by IM nail entry site. 1 case showed radial nerve palsy, and 1 case showed axillary nerve palsy in the case of IM nailing. Also, secondary surgery due to complications was operated in 9 cases (32.1%) in IM nailing and 1 case (4.8%) in plate fixation (p=0.03). CONCLUSION: In the case of traumatic humeral shaft fracture plate fixation by posterior approach was more useful than IM nailing in the decrease of complications and bone union. Such approach is thought to be an excellent method for anatomic reduction and nerve exploration in the case of open and comminuted fracture which accompany nerve injuries
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Humans , Follow-Up Studies , Fractures, Comminuted , Paralysis , Prospective Studies , Radial Nerve , Rotator Cuff , ShoulderABSTRACT
Objective To study whether closed reduction and interlocking intramedullary nailing will worsen the injured radial nerve associated with the fracture of humeral shaft.Methods Of the 353 patients with fracture of humeral shaft who received operation from January 2002 to January 2005,63 ones were complicated with preoperative injury to their radial nerve.A retrospective analysis was done of their physical examination records, operative records,X-ray films and results of the treatment.Eleven cases were treated with closed reduction and interlocking intramedullary nailing,and 52 cases with open reduction and internal fixation of plates and screws fol- lowed by exploration to the radial nerve.Chisquare test of PEMS 3.1 system was adopted to analyze the clinical data. Results The radial nerve was embedded by the fracture ends in nine cases(17.3%)of the 52 cases,and con- tused in the other 43 ones.In the 63 cases,The injured nerves recovered spontaneously 2 to 12 weeks postoperatively except in twn cases.All the eases got bony union 3 to 4 months after operation.Closed reduction and interlocking intramedullary nailing has hardly more harmful effects on the injured radial nerve assoeiated with the fracture of humeral shaft than open reduction and internal fixation of plates and screws followed by neural exploration.Con- clusion Closed reduction and interlocking intramedullary nailing is fit for the freatment of fractures of humeral shaft with radial nerve injury.
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Objective To evaluate the operative treatment of nonunion of humeral shaft fracture with in- ternal plate fixation and autogenous cancellous hone graft.Methods Forty-one cases of nonunion of humeral shaft fracture operatively treated from February 2002 to December 2004 were analyzed retrospectively.There were 32 males and nine females.Their average age was 37.5 years(range,17 to 67 years).Sixteen nonunions were defined as hypertrophic and 25 as atrophic.We followed all the patients and obtained their complete medical information. Results Our average follow-up was 22.6 months(range,8 to 42 months).Forty fractures(97.6%)were united within an average of 5.8 months(range,3 to 12 months).Complications included iatrogenic radial nerve injury in three patients,wound infection in one patient and fracture nonunion in one patient.At the final follow-up,shou]der and elbow functions were found to be satisfactory.Conclusion Open reduction and plate internal fixation sup- plemented with autogenous cancellous bone graft is an effective treatment for nonunion of humeral shaft fracture.