ABSTRACT
BACKGROUND: Fractures of the humerus diaphysis are common and often result from motor vehicle accidents (MVAs). Treatment methods range from nonoperative approaches to various operative techniques, including antegrade intramedullary nailing (AIMN) and dynamic compression plate (DCP) fixation. This study aimed to compare the cost effectiveness and outcomes of plating and nailing for humerus diaphyseal fractures. METHODS: A retrospective cohort study involving 59 cases of humerus diaphyseal OTA/AO 12-A fractures was conducted at King Saud Medical City (KSMC), a level I trauma center located in the center region in Riyadh, Saudi Arabia. Patients treated with AIMN, anterolateral plating, or posterior plating were included. Data on demographics, clinical parameters, radiographic healing, and costs were collected and analyzed. RESULTS: The average surgical duration was shorter in the AIMN group compared to the anterolateral and posterior plating groups but with no statistical significance (P > 0.05). The average length of stay (LOS) was shorter, and the change in hemoglobin levels was lower in the AIMN group when compared to other groups but without a statistically significant difference (P > 0.05). The average cost of AIMN was significantly higher than that of anterolateral and posterior plating groups (P < 0.0001). CONCLUSION: While both nailing and plating procedures are options for treating OTA/AO 12-A fractures, AIMN carries a higher overall procedural cost. The practice of drain placement in our study population is likely the cause of the increased LOS in the plating groups. Relative additional analgesic requirements were associated with AIMN. Surgeons should consider meticulous hemostasis to avoid drain placement, which can decrease LOS, thus possibly decreasing unnecessary treatment costs of humerus shaft fractures.
ABSTRACT
Fractures of the patella constitute approximately 1% of all skeletal injuries. The vertical pattern represents 12-17% and the open patella fracture represents 6-30%. We here represent a rare case constituting the presence of these two uncommon (vertical type patella fracture with depression of articular surface). A 22-year-old male had a close patella fracture after a road traffic accident. The fracture was classified as a vertical and comminuted pattern. A back slab above the knee was applied and then the patient was prepared for surgery. Open reduction and internal fixation of the patella by miniplate and bone graft restore the articular surface, which reduces the risk of post-traumatic osteoarthritis. At five months postoperatively, the patient had a satisfactory joint motion with full extension and 120° of joint flexion and returned to his daily life activities without restriction. Additionally, the patient was in good health and able to bear full weight. In conclusion, the treatment choice requires a thorough knowledge of the case to ensure good stability and avoid fracture displacement.
