Evaluation of Results of Different Treatment Modalities in Management of Diaphyseal Fractures of Humerus.

ABSTRACT

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.