Anteromedial Surface Plating for Midshaft Fracture Humerus Through an Anterolateral Approach - A Better Option than Anterolateral Plating

@#Introduction: Osteosynthesis by plate fixation of humeral shaft fractures as a gold standard for fracture fixation has been proven beyond doubt. However, during conventional anterolateral plating Radial nerve injury may occur which can be avoided by applying plate on the medial flat surface. The aim of this study was to evaluate the results of application of plate on the flat medial surface of humerus rather than the conventional anterolateral surface. Materials and Methods: This study was conducted between Oct 2010 to Dec 2015. One-hundred-fifty fracture shafts of the humerus were treated with the anteromedial plating through the anterolateral approach. Results: One-hundred-fifty patients with a fracture shaft of the humerus were treated with anteromedial plating. Twenty were female (mean ±SD,28 years±4.5) and 130 were male (mean ± SD, 38 years±5.6). One hundred and forty-eight out of 150 (98.6%) patients achieved union at 12 months. Two of three patients developed a superficial infection, both of which were treated successfully by antibiotics and one developed a deep infection, which was treated by wound debridement, prolonged antibiotics with the removal of the plate and subsequently by delayed plating and bone grafting. Conclusion: In the present study, we applied plate on the anteromedial flat surface of humerus using the anterolateral approach. It is an easier and quicker fixation as compared to anterolateral plating because later involved much more dissection than a medial application of the plate and this application of plate on a medial flat surface, does not required Radial nerve exposure and palsy post-operatively. The significant improvement in elbow flexion without brachialis dissection is also a potential benefit of this approach. Based on our results, we recommend the application of an anteromedial plate for treatment of midshaft fractures humerus.

Delayed Brachial Artery Occlusion after Humeral Shaft Open Fracture: A Case Report

Although vascular injury after humeral fracture is very rare, it is a complication that has serious sequelae. It has been associated with proximal humeral fracture or shoulder dislocation in adults and humeral supracondylar fracture in children. However, delayed brachial artery occlusion after humeral shaft fracture has never been reported worldwide. Nevertheless, delayed brachial artery occlusion after humerus shaft fracture has the potential to cause serious complications in the short term as well as long term; therefore, it is essential to provide accurate diagnosis and prompt treatment. We report a case of delayed brachial artery occlusion after humeral shaft open fracture that was successfully treated with early diagnosis as well as effective treatment.

The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing

PURPOSE: For conservative treatment of shaft fractures, the butterfly fragments that were somewhat larger in the closed intra-medullary (IM) nailing. The results of treatment were monitored using radiography separately for the weight-bearing femur and non-weight-bearing humerus. MATERIALS AND METHODS: 27 from Group I and 31 from Group II. In the two groups, the displacement and angulation changes in the fragments, and the degree of improvement of these two factors, were compared using follow-up radiography. RESULTS: The mean angulation of fragments in Groups I and II were 9.2degrees and 9.6degrees, and the mean degree of displacement of the fragments in Groups I and II were 16.7 mm and 21.2 mm, respectively. Follow-up radiography showed that the above factors improved in both groups. The degree of displacement was significantly lower in the normal cases than in the complicated cases (p=0.001). CONCLUSION: Displacement and angulation gradually improved in both groups. It was found that the degree of displacement after the initial reduction is more important than the influence of anatomical position or weight bearing. This indicates that care should be taken when inserting IM nails to prevent displacement or angulation.

Pathologic Fracture Due to an Osteoblastoma of the Humerus Shaft: A Case Report / 대한골관절종양학회지

Osteoblastoma is rare, benign, bone-forming tumor that often occur in the spine. There are few reports of osteoblastomas resulting in pathologic fractures involving long bones. Authos report a unique case of a pathologic fracture due to an osteoblastoma of the humerus shaft. The tumor was treated successfully by curettage, intramedullary nailing and bone allograft.

Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion

PURPOSE: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. MATERIALS AND METHODS: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. RESULTS: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. CONCLUSION: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results

Study on clinical effect and interrelated questions of revolving self-lock nails and normal operative therapy for humerus shall fracture / 中国矫形外科杂志

[Objective]To summarize the clinical effect of revolving self-lock nails and normal operative therapy for humerus shaft fracture,and discuss the perfect treatment methods.[Method]We retrospectively analyzed and compared the outcome and complications of the the humerus shall fracture by normal operative therapy in 96 cases(compression plate 42 cases,monolateral fixator 26 cases,embracing fixator 28 cases);revolving self-lock nails 39 cases.[Result]The operative time,volume of blood loosing,the radial nerve injury,the infection rate and the breakage rate of the group treated with normal operative therapy were obviously more than the group treated with revolving self-lock nails,and the satisfactory rate after operation of the group treated with normal operative therapy was less than the group treated with revolving self-lock nails.[Conclusion]Revolving self-lock nails can avoid much shortcoming of transverse locking nails.The advances of revolving self-lock nails are convenient in operative procedure,with little invasive of operation,solid internal fixation and safety compared with the normal operative therapy.And revolving self-lock nails has two kind choices:anterograde transfixation and retrograde transfixafion,thus it can protect function of shoulder joint in some ways,so revolving self-lock nails is one of the idea choices to treat the fracture of shaft of humerus.In opposition,normal operative has much shortage and it is restricted by type of fractures.

Treatment of Humeral Shaft Fracture with Retrograde Flexible Nail

PURPOSE: To evaluate and report the clinical and radiological results of the intramedullary fixation by retrograde flexible nail in the humeral shaft fracture. MATERIALS AND METHODS: From July 2002 to May 2005, seventeen cases who had the humeral shaft fracture were treated with the intramedullary fixation by retrograde flexible nail. Fifteen cases were followed up and the clinical and radiological results were analyzed. RESULTS: All of the cases had satisfactory fracture union, and none of the patient had limitation in shoulder or elbow joint movement, and shoulder or elbow joint pain, and average ASES was 42.86 point. There was 1 case of delayed union, and 3 cases of distal nail displacement. Another severe complications were not occurred. CONCLUSION: Intramedullary fixation by retrograde flexible nail is one of the effective method in the humeral shaft fracture without nerve or vessel injuries, and also can avoid the complication of wide soft tissue incision or rotator cuff injury.

Nonunion of the Humerus Shaft

PURPOSE: To evaluate the cause and treatment results of nonunion of humerus shaft fractures. MATERIALS AND METHODS: 39 cases were treated for humerus shaft nonunion between February 1990 and May 2002. The presence of open wounds, initial treatment modality after injury, treatment method for the nonunion and time to union were studied using medical records. The fracture type and appropriateness and problems of the initial surgical treatment were reviewed. Also, Pain and functional recovery in daily living were evaluated in the outpatient clinic, after surgery for nonunion. RESULTS: Amongst the 30 cases, transverse fracture was the most common with 19cases. Most of 29 cases, initially surgically treated, revealed incorrect selection of the internal fixator or technical errors. For surgical treatment of nonunion, open reduction and internal fixation with cancellous bone graft was performed, most commonly, in 36 cases (92.3%). All cases showed clinical and radiographic union at an average of 13.3 weeks. More than 90% of the patients replied minimal pain and excellent functional recovery of daily living at final follow-up. CONCLUSION: If treated with surgery by correct selection of internal fixation methods and accurate technical skills, nonunion incidence can be reduced.

Spontaneous Healing of the Hypervascular Nonunion of Humeral Shaft: A Case Report / 대한정형외과학회잡지

No abstract available.

Fracture of the Humerus from Throwing Hand Grenades: 4 Case Report / 대한정형외과학회잡지

Fractures of the shaft of the humerus due to muscle violence esp. from throwing hand grenades are uncommon. Even so there are reports from many authors documenting such fractures from throwing a javerin, baseball, hand grenade and arm wrestling. Fractures of this type are usually spiral in nature; located between the middle and distal third of the humerus. We have treated four such cases during activities in which hand grenades were thrown. These fractures were sustained by military recruits in the Department of Orthopaedic Surgery, Capital Armed Forces General Hospital from Jan. 1980 Dec. 1980.