scholarly journals An Unusual Case of Humeral Shaft Non-Union

2020 ◽  
pp. 1-4
Author(s):  
Claudio Chillemi ◽  
Claudio Chillemi ◽  
Marco Damo ◽  
Nello Russo ◽  
Domenico Paolicelli ◽  
...  
Keyword(s):  
Dynamic Compression ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Complete Healing ◽  
Humeral Shaft ◽  
Left Shoulder ◽  
External Fixators ◽  
Non Union ◽  
Rotator Cuff Insufficiency

Background: Humeral shaft fractures account for 1% to 3% of all fractures and approximately 20% of all fracture involving the humerus. The prevalence of non-union for diaphyseal humeral fractures has been reported as 1% to 10% after non-surgical and 10% to 15% after surgical management. Various devices used in treatment of humeral diaphyseal non-union are limited contact dynamic compression plates, locking compression plate (LCP), wave plates, humerus interlocking nail (IMN), Ilizarov external fixators and bone graft struts. Case Description: A 68-year-old man reported a humeral shaft fracture on the left side, due to a simple fall. It was reduced and fixed by IMN. He underwent clinical and radiological follow up. Three months after the intervention, due to persistent pain and impaired function of the left shoulder, the nail was removed and a cemented endoprosthesis was implanted. 3 years later, unsatisfied with the results, he came to our attention and was diagnosed an atrophic non-union in the site of the previous humeral shaft fracture. Moreover, the exams showed a rotator cuff insufficiency. It was decided to perform a single-stage intervention to achieve two goals: cure the humeral shaft non-union and restore the function of the left shoulder. The cemented endoprosthesis was removed, followed by an extensive curettage of the non-union site. A reverse prosthesis was implanted, with an extra-long stem used to stabilize the non-union site, as it was an IMN. An allograft was harvested from a cadaver femur and fixed with two metal cerclages. The patient underwent clinical and radiological follow-up. Complete healing was achieved 8 months later. Conclusion: Humeral shaft nonunion still represent a pathology that pose a serious problem to the surgeon. A correct management should include an accurate pre-operative planning, to achieve the best result possible for the patient.

scholarly journals The modified anterolateral approach to the humerus

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986595
Author(s):  
Angela Christine Chang ◽  
Ngoc Buu Ha ◽  
Christopher Sagar ◽  
Gregory Ian Bain ◽  
Domenic Thomas Leonello
Keyword(s):  
Plate Osteosynthesis ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Muscle Fibres ◽  
Anterolateral Approach ◽  
Non Union ◽  
Small Series ◽  
Brachialis Muscle

Introduction: The anterior and anterolateral approaches to the humerus describe splitting brachialis longitudinally, assuming its fibres run parallel to the shaft. Recent improvements in the understanding of brachialis anatomy however have demonstrated it has two distinct heads, with the bulk of its fibres running oblique relative to the humerus. Attempting to split brachialis longitudinally to the extent required for plate osteosynthesis invariably leads to transection of a significant number of muscle fibres. The authors present a less muscle destructive modification to the anterolateral approach (ALA) based on a bicipital brachialis muscle. Method: In order to preserve brachialis muscle fibres, the modified ALA elevates the superficial head from the underlying humerus and longitudinally splits the deep head to allow a fixation device to be tunnelled. Case notes of patients with a humeral shaft fracture fixed via the modified ALA were retrospectively reviewed. Results: Ninteen humeral shaft fractures were fixed via the modified ALA. No post-operative nerve palsies were reported. Of the 19 patients, 14 (73.7%) received clinical and radiological follow-up. All reported being satisfied with their outcome. One developed a superficial wound infection and one (previous diagnosis of spondyloepiphyseal dysplasia tarda) developed a non-union requiring revision surgery. Of the five patients lost to follow-up, two died, and three reported no ongoing orthopaedic issues via telephone. Conclusions: Improved anatomical understanding of brachialis has resulted in the described modification to the ALA which is less muscle destructive and follows a truer inter-nervous plane. This small series demonstrates satisfactory outcomes using this approach.

scholarly journals A Retrospective Analysis of Plate Fixation of Humerus Fracture

2021 ◽  
Vol 7 (2) ◽  
pp. 28-35
Author(s):  
Dr. Sunil Kumar Kirar ◽  
◽  
Dr. Sanjay Upadhyay ◽  
Dr. Sanat Singh ◽  
Dr. Atul Varshney ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Surgical Site Infections ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Hospital District ◽  
Non Union ◽  
Surgical Expertise

Introduction: Humeral shaft fractures represent 1–3% of all the fractures coming in our OPD.These fractures are mostly treated conservatively. Both the plate fixation and nailing techniques arebeing used but plate fixation has the advantage of lesser rates of malunion and non-union. Ourstudy aimed to evaluate the results of plate fixation in our hospital that employs plate fixation as thegolden standard. Materials and Methods: This was a retrospective cohort study of all patientstreated for a humeral shaft fracture in our hospital (District Hospital Vidisha associated with ABVMedical College, Vidisha between July 2018 and June 2020 with a mean follow-up of 6 months.Results: Plate fixation was performed in 40 patients with a humeral shaft fracture. The mean agewas 50 (SD 20) years with 60 % (n = 24) being male. There were 55 % (n = 22) fractures in theright and 45 % (n =18) fractures in the left. None of the patients develops superficial surgical siteinfection. Complications like Radial Nerve palsy, Deep surgical site infections and Non-union occurredin 2.5 % (n = 1), 2.5 % (n = 1) and 5 % (n = 2) of patients, respectively. The median duration ofradiological fracture healing was 18 (range 10–42) weeks. Conclusion: Plate fixation for humeralshaft fractures has low risks of complications. The complications can be further minimized withgreater surgical expertise.

scholarly journals Application of Ultrasonography in Conservative Treatment of Humeral Shaft Fracture in Children

2021 ◽  
Author(s):  
Jun Li ◽  
Xin Tan ◽  
Xiang Li ◽  
Pan Gou ◽  
Xiaowei Yuan ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Nerve Injury ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Dash Score ◽  
X Ray ◽  
Epidemic Period ◽  
Significant Difference

Abstract Purpose: Most of humeral shaft fractures in children could be treated satisfactorily by conservative treatment. This study aimed to evaluate the application value of ultrasonography in conservative treatment of humeral shaft fracture in children.Methods: We retrospectively reviewed children admitted to our hospital, for humeral shaft fracture from January 2014 to March 2018. The patients were divided into two groups: ultrasonography group and X-ray group. All patients were instructed to re-examined at 1 week, 2 weeks, 4 weeks, 12 weeks, 24 weeks and 1 year from the injury date for follow-up, and evaluated the prognosis according to the Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months.Results: A total of 37 children were divided into ultrasonography group, 32 children were divided into X-ray group. There was no significant difference in prognosis between the two groups. The mean number of radiation exposures of ultrasonography group was less and ultrasonic examination found radial nerve injury, and using ultrasound reduced the chance of direct or in direct contact with infected peoples.Conclusion: Ultrasound is a non-invasive, non-radioactive test, which could decrease risk of COVID-19 infection and detect the vascular nerve injury caused by fracture. Ultrasonography may be the examination method for follow-up conservative treatment of humeral shaft fracture in children during the epidemic period.

Microstructural Features of Non-Union of Human Humeral Shaft Fracture

1997 ◽  
Vol 119 (3) ◽  
pp. 239-246 ◽  
Author(s):  
H.B. Wen ◽  
F.Z. Cui ◽  
X.D. Zhu
Keyword(s):  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Non Union

scholarly journals Midterm Results of Minimally Invasive Plating Osteosynthesis Versus Open Reduction and Internal Fixation for the Treatment of Mid-distal Humeral Shaft Fractures: A Case-match Controlled Comparison Study

2020 ◽  
Author(s):  
Bo Yin ◽  
Jie Gao ◽  
Huayong Zeng ◽  
Zheng Lu ◽  
Yanhong Cai ◽  
...  
Keyword(s):  
Major Complication ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Complication Rates ◽  
Comparison Study ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Distal Shaft

Abstract Background: Surgical treatment of humeral mid-distal shaft fractures is controversial. The purpose of this case-match controlled comparison study was to determine the safety and effectiveness of applying the MIPO technique compared with conventional ORIF for treating humeral mid-distal shaft fractures.Methods: This study was conducted from January 2012 to December 2016, and patients of mid-distal humeral shaft fractures were eligible for this study. The patients were followed up for a minimum period of 1 year. The clinical and radiographic outcomes were evaluated. The inclusion criteria were age between 18 to 60 years and acute displaced mid-distal humeral shaft fracture. The exclusion criteria were intra-articular fractures of the elbow, vascular insufficiency of the upper limb, pathological fracture and multiple or open fractures. The medical records and radiographs of all eligible patients during hospitalization and follow-up after discharge were reviewed. We use a 1:2 (MIPO/ORIF) case-match based on gender and age. All patients had at least 3 years of postoperative follow-up.Results: In total, 216 patients with mid-distal humeral shaft fracture underwent surgery at the departments of orthopedics of the Seventh Medical Center of PLA General Hospital and Beijing Chaoyang Hospital. Of them, 28 underwent MIPO and 56 case-matched controls underwent ORIF; all of them had complete 3-year follow-up data. No significant differences were observed in baseline characteristics between both groups. UCLA scores and MEPS were significantly higher in the MIPO group than in the ORIF group. Furthermore, UCLA score and MEPS grades in the MIPO group were significantly superior to those in the ORIF group. There was no statistically significant difference in major complication rates between both groups; however, the total major complication rate was significantly different between both groups.Conclusion: This study demonstrates that MIPO has a statistically significant clinical benefit over ORIF, including better shoulder and elbow joint function, with few overall major complications after at least 3 years of postoperative follow-up. MIPO is a safe and effective method for treating mid-distal humeral shaft fractures when surgery is indicated.

scholarly journals DCP WITH INTRAMEDULLARY INTERLOCKING NAILS;

2013 ◽  
Vol 20 (06) ◽  
pp. 999-1005
Author(s):  
IMRAN KHAN ◽  
MUHAMMAD AYUB LAGHARI ◽  
SHAKEEL AHMED MEMON ◽  
Muhammad Khan Pahore
Keyword(s):  
Road Traffic ◽  
Dynamic Compression ◽  
Adhesive Capsulitis ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
University Hospital ◽  
Systemic Review ◽  
Base Line ◽  
Female Ratio

Objective: The objectives of the study are to compare the outcome of dynamic compression plates with intramedullarynails in closed diaphyseal humeral shaft fracture with type A1-2 , A2-2 and A3. Study Design: Comparative study. Place and duration ofstudy: Study was carried out at the Orthopaedics Unit-I, Liaquat University Hospital Hyderabad / Jamshoro , from March 2007 to Feb2009. Methodology: Study consisted of 40 patients of diagnosed cases of closed diaphyseal humeral shaft fracture with type A1-2 , A2-2and A3. Patients were divided in two groups. Group A for dynamic compression plates and group B for intramedullary nails. DetailedClinical examination of the patient was done and recorded in proforma. Systemic review was also done to see any major or minor headinjury. All patients underwent for base line investigation. In Inclusion criteria; patients with type A1-2 , A2-2 and A3-2 closed diaphysealhumeral shaft fracture ,bilateral fractures, associated with minor head injuries, age between 20-40 years and fracture not more than twoweeks old. In Exclusion criteria ; Open fracture, associated with severe chest or abdominal injuries, pathological fractures and malunitedfractures with neurological deficit. Follow up of all these patients was done .1st four visit after every week , then alternet week upto 3rdmonth then monthly upto 6 month to assess any complication. Results were prepared with help of tables and graphs. Data was analyzedthrough SPSS software version 16.0. Results: In both groups male were 35(87.5%) and female 5(12.5%) with male: Female Ratio of 7:1.There was wide variation of age ranging from a minimum of 20 year to 40 year in both group. The mean age was 29.78+3.5 years. Themost common cause of fracture shaft of humerus was road traffic accident (RTA). There were 23( 57.5%) patients who sustainedfractures of the humerus following road traffic accidents. Eight (20%) cases had fractures shaft of humerus after fall from height and 9 (22.5 %) cases had fractures shaft after assault. The Fracture pattern was Oblique in 22(55%) cases ,Transverse in 12( 30%) and Spiral in6(15 %) . Severity of post operative pain in both groups was recorded. Mild pain was felt in 10(50%) patients of DCP group and 6 (30%)patients of IMN group, Moderate pain was seen in 7(35%) patients of DCP group and 10 (50%) patients of IMN group, severe pain wasdescribed by 3(15%) patients in DCP group and 4 (20%) patients in IMN group. The complications seen in this study were Infection(1(5%) patients in DCP VS 0(0%) patients in IMN group), Iatrogenic palsy of radial nerve (1(5%) patients in DCP VS 0 (0%) patients in IMNgroup), Non union (1(5%) patients in DCP VS 1 (5%) patients in IMN group),Severe impingement (0(0%) patients in DCP VS 3 (15%)patients in IMN group), Adhesive capsulitis (0(0%) patients in DCP VS 2 (10%) patients in IMN group ). However minimal loss of fixation in1 (5%) cases and late fracture occurred in one case 5%. The duration of hospital stay varied from 1 to 20 days. It was longer about -10-20days in 12(60%) of DCP patients as compared to IMN cases where majority 11(55%) were discharged within 1 to 10 days. The meanhospital stay in DCP group was 15 days and IMN group was 13.5 days. Conclusions: Dynamic compression plate is a safe and effectiveprocedure for treatment of humeral shaft fractures. With low threshold of complications it has significant advantages over intramedullarynails procedure revealed with earlier mobilization, minimum hospitalization and fast recovery towards normal life.

scholarly journals HUMERAL SHAFT FRACTURES

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. 

Sign in / Sign up

Export Citation Format

Share Document