A comparative study of 6-week and 12-week Radiographic Union Scores for HUmeral fractures (RUSHU) as a predictor of humeral shaft non-union

2021 ◽  
pp. 175857322110331
Author(s):  
Borna Guevel ◽  
Kishan Gokaraju ◽  
Foad Mohamed ◽  
Frederik Sorensen ◽  
Elizabeth Gillott ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Humeral Fractures ◽  
Humeral Shaft ◽  
Significant Morbidity ◽  
Post Injury ◽  
Non Union ◽  
Humeral Shaft Fractures ◽  
Diaphyseal Fractures ◽  
Robust System ◽  
Radiographic Union

Background Non-union in non-operatively managed humeral shaft fractures are associated with significant morbidity. Hence, developing a robust system that could help with early diagnosis is important. We aimed to evaluate the validity of the Radiographic Union Score for HUmeral fractures (RUSHU) at 6 weeks (RUSHU-6) and test whether a RUSHU at 12 weeks (RUSHU-12) would be a better predictor of non-union. Methods We retrospectively reviewed all non-operatively managed humeral diaphyseal fractures from 2012 to 2018. Statistical analysis was used to determine the cut-off RUSHU-12 and evaluate the effect of RUSHU-6 and RUSHU-12 on non-union prediction. Results In sum, 32 patients had radiographs at 6 weeks post-injury, 27 of which also had radiographs at 12 weeks. A RUSHU cut-off of 9 was the best predictor of non-union at 12 weeks. Only RUSHU-12 had a statistically significant influence predicting non-union (P = 0.011) and there was a significant correlation (P = 0.003) between score progression from RUSHU-6 to RUSHU-12 and the development of non-union. Discussion A RUSHU-12 of <9 and a low score progression between 6 and 12 weeks suggest superior predictive value in determining the likelihood of non-union. Further validation in the form of a large multicentred study is however required.

The Radiographic Union Score for HUmeral fractures (RUSHU) predicts humeral shaft nonunion

2019 ◽  
Vol 101-B (10) ◽  
pp. 1300-1306 ◽  
Author(s):  
William M. Oliver ◽  
Thomas J. Smith ◽  
Jamie A. Nicholson ◽  
Sam G. Molyneux ◽  
Tim O. White ◽  
...  
Keyword(s):  
Predictive Value ◽  
Characteristic Curve ◽  
External Validation ◽  
Intraclass Correlation ◽  
Area Under The Curve ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Fractures ◽  
Humeral Shaft ◽  
Radiographic Union

Aims The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic Union Score for HUmeral fractures (RUSHU). The secondary aim was to assess whether the six-week RUSHU was predictive of nonunion at six months after the injury. Patients and Methods Initially, 20 patients with radiographs six weeks following a humeral shaft fracture were selected at random from a trauma database and scored by three observers, based on the Radiographic Union Scale for Tibial fractures system. After refinement of the RUSHU criteria, a second group of 60 patients with radiographs six weeks after injury, 40 with fractures that united and 20 with fractures that developed nonunion, were scored by two blinded observers. Results After refinement, the interobserver intraclass correlation coefficient (ICC) was 0.79 (95% confidence interval (CI) 0.67 to 0.87), indicating substantial agreement. At six weeks after injury, patients whose fractures united had a significantly higher median score than those who developed nonunion (10 vs 7; p < 0.001). A receiver operating characteristic curve determined that a RUSHU cut-off of < 8 was predictive of nonunion (area under the curve = 0.84, 95% CI 0.74 to 0.94). The sensitivity was 75% and specificity 80% with a positive predictive value (PPV) of 65% and a negative predictive value of 86%. Patients with a RUSHU < 8 (n = 23) were more likely to develop nonunion than those with a RUSHU ≥ 8 (n = 37, odds ratio 12.0, 95% CI 3.4 to 42.9). Based on a PPV of 65%, if all patients with a RUSHU < 8 underwent fixation, the number of procedures needed to avoid one nonunion would be 1.5. Conclusion The RUSHU is reliable and effective in identifying patients at risk of nonunion of a humeral shaft fracture at six weeks after injury. This tool requires external validation but could potentially reduce the morbidity associated with delayed treatment of an established nonunion. Cite this article: Bone Joint J 2019;101-B:1300–1306

scholarly journals Minimally Invasive Helical Plating for Shaft of Humerus Fractures: Technique and Outcome

2012 ◽  
Vol 6 (1) ◽  
pp. 184-188 ◽  
Author(s):  
James Chung Hui Tan ◽  
Fareed Husain Yusuf Kagda ◽  
Diarmuid Murphy ◽  
Joseph S Thambiah ◽  
Kok Sun Khong
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Lateral Approach ◽  
Humeral Shaft ◽  
Fixation Failure ◽  
Non Union ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Elbow Function ◽  
Helical Plate

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.

Reliability of Radiographic Union Scoring in Humeral Shaft Fractures

2020 ◽  
Vol 34 (12) ◽  
pp. e437-e441 ◽  
Author(s):  
Christopher A. Schneble ◽  
Don T. Li ◽  
Joseph Kahan ◽  
Jordan Brand ◽  
Adrienne Socci ◽  
...  
Keyword(s):  
Humeral Shaft ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Radiographic Union

Supracondylar Femoral Nail in the management of non-union of humeral shaft fractures

Injury ◽  
2004 ◽  
Vol 35 (5) ◽  
pp. 523-527 ◽  
Author(s):  
S.K Bajaj ◽  
N Rama Mohan ◽  
C.Senthil Kumar
Keyword(s):  
Humeral Shaft ◽  
Non Union ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Femoral Nail

L-T2.5 The long telegraph nail for humeral shaft fractures – how to avoid non-union

Injury ◽  
2012 ◽  
Vol 43 ◽  
pp. S4-S5
Author(s):  
C. Cuny ◽  
M'B. Irrazi ◽  
A. Berrichi ◽  
N. Ionescu ◽  
P.-Y. Le Coadou ◽  
...  
Keyword(s):  
Humeral Shaft ◽  
Non Union ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures

scholarly journals Comparative study of operative management of humeral shaft fractures by dynamic compression plating versus locked intra-medullary nailing

2017 ◽  
Vol 3 (5) ◽  
pp. 956
Author(s):  
Kiran Kumar Koppolu Kanthi ◽  
Maheshwar Lakkireddy ◽  
Vikas Reddy Bollavaram ◽  
Siva Prasad Rapur
Keyword(s):  
Plate Osteosynthesis ◽  
Dynamic Compression ◽  
Treatment Options ◽  
Operative Management ◽  
Humeral Shaft ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Medullary Nailing ◽  
Diaphyseal Fractures ◽  
Nail Osteosynthesis

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Operative management of humeral shaft fractures is mostly accomplished by surface plating or intra-medullary nail osteosynthesis. Both the treatment options have been variably reported to give good rates of union and functional outcome. We compared both the options to know the better one in multitude of variables.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Thirty patients with fracture shaft of humerus were followed up for a period of 12 to18 months. 15 patients each underwent open reduction and internal fixation with dynamic compression plate and closed antegrade locked intra-medullary nailing. All patients were clinically and radiologically assessed till fracture union</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Diaphyseal humeral fractures in all the patients treated with nailing united and had a tendency to unite early compared to plating. Shoulder pain was initially complained by 2 patients from the nailing group and got subsided later on. The incidence of complications was more in the plate osteosynthesis group. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study Intra-medullary nailing turned out to be superior to plating for amenable diaphyseal fractures of humerus in terms of higher rate of union, early union and lesser complications.</span></p>

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