Factors predicting patient-reported functional outcome scores after humeral shaft fractures

Introduction: The humerus is subjected to substantial amount of torsional stress. Conventional plating may not address this sufficiently and may lead to fixation failure or non-union. A helical plate may offer the solution. We present the surgical technique and functional outcome of 5 cases of humeral shaft fractures treated with this technique in a minimally invasive way. Materials and Methods: The operations were performed between 2004 and 2010, by three surgeons. All the patients had closed humeral shaft fractures, either simple transverse or with mild comminution. Two small incisions were made. The proximal incision was placed along the deltopectoral groove over the shaft, and the distal incision was placed as in an antero-lateral approach. The radial nerve was identified and protected. A pre-selected plate was contoured and introduced in the submuscular plane. The plate was placed in a proximal-lateral and distal-anterior position. Screws were inserted through stab incisions. The patients were followed for an average of 6 months. Functional recovery of the shoulder and elbow was assessed using the Constant and Mayo elbow performance score systems. Results: All incisions healed by first intention without complications and all the fractures went on to unite. All patients achieved good to excellent shoulder and elbow function. Conclusion: The helical plate technique is a safe and effective method of treating humeral shaft fractures and has good functional outcome.

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Clinical results and functional outcome of humeral shaft fractures treated with MIPO technique

Basrah Journal of Surgery ◽

10.33762/bsurg.2020.127563.1000 ◽

2020 ◽

Vol 26 (2) ◽

pp. 38-47

Author(s):

Ashish Jaiman ◽

Rajat Ranjan ◽

Rajesh Chopra

Keyword(s):

Functional Outcome ◽

Clinical Results ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures

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Treatment of humeral shaft fractures using antegrade nailing: functional outcome in the shoulder

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2015.01.009 ◽

2015 ◽

Vol 24 (8) ◽

pp. 1302-1306 ◽

Cited By ~ 3

Author(s):

Juan Martin Patino

Keyword(s):

Functional Outcome ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Antegrade Nailing

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Functional outcome of antegrade interlocking intramedullary nailing for humeral shaft fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174147 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1127

Author(s):

Rajagopal H. P. ◽

Madan Mohan M. ◽

Anoop Pilar ◽

Keith Behram Tamboowalla

Keyword(s):

Functional Outcome ◽

Intramedullary Nailing ◽

Shoulder Function ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Fracture Union ◽

Permanent Disability ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Shoulder Score

Background: Humeral shaft fractures which account for approximately 1-3% of all fractures and 20% of humeral fractures have potential to cause significant disability in the young which is often temporary and in the old often permanent disability. The use of locked intramedullary nailing for the treatment of humeral shaft fractures is gaining popularity because of its biomechanical and biological advantages.Methods: We present a descriptive retrospective review of 20 consecutive patients with acute humeral shaft fractures treated using an antegrade interlocking nail. Fracture union, functional outcome measured with Constant–Murley shoulder score and American shoulder and elbow surgeons (ASES) shoulder score and complications were assessed.Results: Patient age ranged from 20 to 74 years (average, 36 years) and average follow-up was 30.7 months (range, 12–48 months). There were 13 male patients and 7 female patients. Fracture of the middle third was most common accounting to 80% (16/20) of the fractures. Fracture union was achieved in 90% (18/20) of our cases. 2 patients had nonunion for which secondary surgeries were needed. According to Constant–Murley score, shoulder function was excellent in 70% (14/20) and good in 25% (5/20). Average ASES score was 93.3%. None of the patients had radial nerve palsy postoperatively. Conclusions: Gentle progressive reaming, correct entry point, minimal damage to rotator cuff, properly embedding the tip of the nail, good apposition of fracture fragments, static locking will help make antegrade intramedullary nailing, a dependable solution for the treatment of humeral shaft fractures and in achieving successful union with preserved/good shoulder and elbow function.

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Surgical Versus Non-Surgical Treatment of Humeral Shaft Fractures Compared By a Patient Reported Outcome: The Scandinavian Humeral Diaphyseal Fracture Trial (SHAFT) - A Study Protocol For a Pragmatic Randomized Clinical Trial

10.21203/rs.3.rs-882545/v1 ◽

2021 ◽

Author(s):

Dennis Karimi ◽

Stig Brorson ◽

Kaare S. Midtgaard ◽

Tore Fjalestad ◽

Aksel Paulsen ◽

...

Keyword(s):

Surgical Treatment ◽

Controlled Trial ◽

Patient Reported Outcome ◽

Humeral Shaft ◽

Major Adverse Cardiovascular Events ◽

Dash Score ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Patient Reported ◽

Non Surgical Treatment

Abstract Background: The outcome of non-surgical treatment is generally good, but the treatment course can be long and painful with approximately a quarter of the patients acquiring a nonunion. Both surgical and non-surgical treatment can have disabling consequences such as nerve injury, infection and nonunion. The purpose of the study is to compare patient reported outcome after surgical and non-surgical treatment for humeral shaft fractures. Methods: A pragmatic randomized controlled trial is planned with two study groups (SHAFT-Y and SHAFT-E). A total of 287 eligible acute humeral shaft fractures are scheduled to be recruited and randomly allocated to surgical or non-surgical treatment with the option of early crossover due to delayed union. The surgical method within the allocation is decided by the surgeon. The primary outcome is the Disability of Arm, Shoulder and Hand (DASH) score at 52 weeks, and is assessor blinded. The secondary outcomes are DASH score, EQ-5D-5L, pain assessed by visual analogue score, Constant-Murley score including elbow range of motion and anchor-questions collected at all timepoints throughout the trial. All complications will be reported including; infection, nerve or vascular injury, surgical revisions (implant malpositioning, hardware failure, aseptic loosening and peri-implant fracture), major adverse cardiovascular events, and mortality. Patients declining randomization will be asked to enroll into an observational cohort with same outcomes and post-treatment regimes. Discussion: SHAFT will provide information on the effectiveness of two standard treatments for humeral shaft fractures, while taking the dilemmas within the population into account. Trial registration: Clinicaltrials.gov, NCT04574336. Registered on 5 October 2020.

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Functional outcome of humeral shaft fractures in adults treated with titanium elastic nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182033 ◽

2018 ◽

Vol 4 (4) ◽

pp. 582

Author(s):

Ishani Patel ◽

Dhaval R. Modi ◽

Mansi Patel

Keyword(s):

Functional Outcome ◽

Good Method ◽

Delayed Union ◽

Humeral Shaft ◽

Fracture Union ◽

Shoulder Stiffness ◽

Humeral Shaft Fractures ◽

Titanium Elastic Nailing ◽

Shaft Fractures ◽

A Prospective Study

Background: This study was done to analyse the functional outcome of humeral shaft fractures (upper and middle third) managed with closed ante-grade intramedullary titanium elastic nailing.Methods: This was a prospective study of 20 patients, aged between 18 and 60 years, with humeral shaft fractures treated with titanium elastic nailing from May 2016 to April 2018 at our institute. Upper and middle humeral shaft fractures of both sexes were included in the study.Results: Eighteen (90%) fractures united in 12-20 weeks. Two (10%) patients had delayed union which ultimately united without any intervention. Two (10%) patients developed shoulder stiffness due to nail impingement. By evaluating ASES score, good to excellent results were noted in 18 (90%) and moderate in 2 (10%). There were 15 males and 5 females with an average age 32.75 years (range: 18-60 years).Conclusions: Titanium elastic nailing is a good method for treatment of humeral shaft fractures in adults. It provides early fracture union, high union rates, minimal soft tissue damage, early rehabilitation and short hospital stay.

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HUMERAL SHAFT FRACTURES

The Professional Medical Journal ◽

10.29309/tpmj/18.5027 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1809-1813

Author(s):

Junaid Khan ◽

Raja Umar Liaqat ◽

Muhammad Imran Aftab ◽

Talia Urooj ◽

Rahman Rasool Akhtar ◽

...

Keyword(s):

Functional Outcome ◽

Dynamic Compression ◽

Operative Management ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Trauma Patients ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Dominant Condition

Objectives: To determine the functional outcome of operative management of humeral shaft fractures. Study Design: Prospective cohort study. Place and Duration: At the Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi, for a duration of 02 years from 12th January 2016 to 11th January 2018. Patients and Methods: 45 patients presenting with humeral shaft fractures and meeting the inclusion criteria were included. All patients underwent fixation with a Dynamic Compression Plate (DCP). Functional outcome assessed at six months post-operatively using the American Shoulder and Elbow Surgeons Scoring System (ASES). Results: Mean age of patients included in the study was 34.6 ± 10.3 years.Out of the 45 patients, 31 (68.9%) were males and 14 (31.1%) females. Pre-dominant condition resulting in operative management was humeral shaft fracture in poly trauma patients (n=27, 60%). Shoulder functioning following surgery was good with a mean ASES score of 81.1±10.6. Conclusion: Plating in humeral shaft fractures results in a good functional outcome postoperatively.

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