New ways of treatment of fractures of the humeral shaft: does the combination of intramedullary nail osteosynthesis and cerclage improve the healing process?

Abstract Introduction The humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage. Methods In this retrospective study, 109 patients were evaluated, who, during a period of 6 years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS. Results and conclusion The healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.

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Treatment of humeral fractures with long PHILOS plates using a modified technique and approach avoids radial nerve palsy in the last 10 years

British Journal of Surgery ◽

10.1093/bjs/znab202.056 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

S Schmeichel ◽

B Oberreiter ◽

D Rikli

Keyword(s):

Radial Nerve ◽

Plate Osteosynthesis ◽

Healing Process ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Surgical Method ◽

Iatrogenic Damage ◽

Philos Plate

Abstract Objective Radialis paresis is a known complication of plate osteosynthesis of the proximal humeral shaft. There are major differences with regard to surgical approach and implant. The standard treatment is a lateral-lateral approach. Here, iatrogenic damage to the radial nerve is a relevant complication. In our institution, these fractures have been treated with an adapted procedure for about 10 years. A long Philos plate is inserted proximally via a deltoido-pectoral approach. The plate is first torqued distally by about 45°-90° and then lies anteriorly on the humerus. The distal screws can be placed via anterior stab incisions. The advantage of this technique is that the implant and approach respect the anatomical course of the radial nerve and it does not have to be manipulated in an open exploratory manner. The aim of the study is to demonstrate the effectiveness of the surgical technique in relation to iatrogenic radial nerve paresis in comparison to the literature. Methods We analysed patients with a proximal humeral shaft fracture who were treated at our clinic with a long torqued philos plate using the adapted surgical method over the last 10 years. The fracture, the occurrence of iatrogenic radial damage and biometric data of the patients were analysed retrospectively. Results We found a total of 59 patients who underwent surgery according to the above-mentioned scheme between 2010 and 2020. The average age was 70.1 (40-101) years. There were 44 women and 15 men. 2 patients had a preoperatively documented radial nerve damage. In 57 patients, no damage could be found in the radialis supply area both pre- and postoperatively. 2 patients died shortly after surgery, 6 patients were loss to follow up. 2 patients had a tear of the distal plate bearing (1 malcompliance/1 pseudarthrosis). Both had to be revised. In the remaining 47 patients (78%), the healing process was unremarkable. Conclusion The described treatment of the proximal humeral shaft fracture has been successfully practised at our clinic for 10 years. Most of the fractures healed without complications. Compared to the exploration of the nerve, this method respects the anatomical course of the nerve and shows in the retrospective analysis that no iatrogenic damage to the radial nerve occurred. Thus, the surgical method represents a valid alternative to the established implants and classical surgical treatments.

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Radial nerve palsy associated with humeral shaft fracture. Is the energy of trauma a prognostic factor?

Yearbook of Hand and Upper Limb Surgery ◽

10.1016/j.yhls.2012.04.086 ◽

2012 ◽

Vol 2012 ◽

pp. 167-168

Author(s):

F.T.D. Kaplan

Keyword(s):

Prognostic Factor ◽

Radial Nerve ◽

Nerve Palsy ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Radial Nerve Palsy

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Result of closed interlocking intramedullary nail in tibial shaft fracture

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v44i1-2.10470 ◽

2012 ◽

Vol 44 (1-2) ◽

pp. 15-17

Author(s):

AHSM Kamruzzaman ◽

S Islam

Keyword(s):

Intramedullary Nail ◽

Joint Stiffness ◽

Shaft Fracture ◽

Autogenous Bone ◽

Tibial Shaft Fracture ◽

Early Mobility ◽

Non Union ◽

Orthopedic Surgeons ◽

Interlocking Intramedullary Nail ◽

Diaphyseal Fractures

The management of tibial diaphyseal fractures has always held a particular interest for orthopedic surgeons. Not only they are relatively common but also they are often difficult to treat. This prospective study was carried out at Rangpur from April 2008 to November 2009. 34 patients were treated by closed interlocking intramedullary nail. Goal of this study was to find out a safe & effective management of fracture, early mobility of patient, functional joint motion and short stay in hospital. Routine follow up was carried out in 29 patients. In 24 cases, fracture (81.76%) were united, 4 cases (13.79%) needed dynamisation with autogenous bone grafting and 1 case devoloped non union. Study showed interlocking nailing in tibia provides early mobility of patients, reduces hospital stay and fracture unites without joint stiffness and less complication.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10470Bang Med J (Khulna) 2011: 44(1&2) 15-17

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Humeral shaft fracture associated with radial nerve palsy -a case report

Journal of Innovations in Applied Pharmaceutical Science (JIAPS) ◽

10.37022/jiaps.v6i3.251 ◽

2021 ◽

pp. 54-55

Author(s):

Rishitha M ◽

Akasha Sindhu M

Keyword(s):

Radial Nerve ◽

Nerve Palsy ◽

Wrist Joint ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Loss Of Function ◽

History Of ◽

The Right

Radial nerve palsy was induced by radial nerve compression, which was often caused by humerus bone fracture. This leads to pain, weakness, or loss of function mostly in the wrist, hand, and fingers. We reported a case of a 24-year-old male patient with complaints of swelling of the right-hand wrist joint and pain during extension and flexion while moving. He had a three-month history of mild displaced humeral shaft fracture from a traffic accident and an intramedullary Ender nailing was performed. He now has been admitted with swelling in his right wrist joint and pain while moving his hand. The case was diagnosed as Radial nerve palsy. Surgery was performed, the proximal and distal ends of the radial nerve were separated at the humeral bone's surface. The radial nerve stumps were enough long to be sutured. Our one-month follow-up shows no complications. The majority cases of radial nerve palsy will resolve within a few weeks after surgery, as our patient did, and the most prominent is patient education.

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