The outcome of nonoperative treatment for adult humeral shaft fractures using a U-shaped slab in resource-limited settings: a prospective cohort study.

BACKGROUND: Humeral shaft fractures, constituting 3-5% of musculoskeletal injuries, are commonly managed conservatively using functional braces. However, this approach may not be feasible in resource-limited settings. This study aimed to evaluate the functional outcomes of nonoperative treatment for humeral shaft fractures in adults utilizing a U-shaped slab. METHODS: This prospective study was conducted from August 2021 to August 2022 involving 16-year-old and older individuals who received nonsurgical treatment for humeral shaft fractures at public tertiary hospitals in Rwanda. The assessment focused on various functional outcomes, including alignment, union rate, range of motion, return to activities of daily living, and DASH score. RESULTS: The study included 73 participants, predominantly males (73.9%), with a median age of 33 years. The union rate was high at 89.04%, and 10.96% experienced delayed union. Radial nerve palsy occurred in 4.11% of patients, but all the patients fully recovered within three months. Despite angular deformities during healing in the majority of participants, these deformities did not significantly impact functional outcomes. According to the international classification of disabilities, 77% of participants achieved a good functional grade. CONCLUSION: The conservative U-shaped slab method was effective at managing humeral shaft fractures. However, optimal results necessitate careful participant selection and comprehensive rehabilitation education. Implementing these measures can improve the overall success of nonoperative management.

A case report of anterior cruciate ligament and posterolateral corner reconstruction using tendon graft preserved in situ.

INTRODUCTION: Combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction are a rare clinical entity in orthopedic literature, whose management requires different types of tendon grafts. Missed PLC injury leads to the failure of ACL repair due to the joint instability. PRESENTATION OF CASE: We are presenting a case of posttraumatic right ACL, PLC and lateral meniscus injury. The patient was taken to theatre for arthroscopic meniscectomy, ACL and PLC reconstruction. We had to harvest bilateral Gracilis and semitendinosus tendon grafts. Intraoperatively, we used a pump and after meniscectomy and ACL reconstruction the knee was quite swollen; we opted to offer a two-staged procedure for PLC reconstruction. Hence we had to preserve the graft in situ for the next procedure. Posterolateral corner reconstruction was done in a week's time and preserved ligament was found to be intact. DISCUSSION: The fact that we did not have a tissue bank or facilities for cryopreservation of the harvested tendons at -80 °C or with liquid nitrogen at -179 °C yet we had to keep the harvested tendons safe. CONCLUSION: In case of absence of graft and bone bank, tendon graft was in situ and found intact and ready to be used after seven days.