EVALUATION OF RESULTS OF NON OPERATIVE TREATMENT OF FRACTURE SHAFT OF THE HUMERUS WITH A FUNCTIONAL BRACE

2021 ◽  
pp. 34-39
Author(s):  
Singh kaushal kishor ◽  
Md Ruhullah ◽  
Shinha KD ◽  
Kushwaha Mukesh kumar
Keyword(s):  
Operative Treatment ◽  
Motor Vehicle ◽  
External Rotation ◽  
Humeral Fracture ◽  
Humeral Shaft ◽  
Shoulder Abduction ◽  
Radial Nerve Palsy ◽  
Functional Evaluation ◽  
Hand Motion ◽  
Functional Brace

Introduction: Fractures of the humeral shaft account for roughly 3% of all fractures due to fall on the outstretched hand, motor vehicle accidents and direct loads to the arm. The brace effectively compresses the bulky biceps and triceps muscle allowing early shoulder, elbow, wrist and hand motion with nonunion and radial nerve palsy in a signicant percentage of humeral shaft fractures. This study intends to assess the results of non-operative treatment of fracture shaft of the humerus with a functional brace. Materials and Methods: Prospective observational study was conducted in NMCTH, Birgunj among 50 patients from 16 years onwards of age who presented with fracture of humerus shaft. The patients with open fracture, oating elbow, bilateral humeral fracture, polytrauma, pathological fracture, additional injury of the extremities and patients with neurologic and psychiatric disorders were excluded from the study. The patients were treated with close reduction and immobilization in functional humeral cast brace and were followed up in outpatient department basis once a week for the rst four weeks and every four weeks subsequently till fracture united. After removal of brace functional evaluation of results of upper limb was done according to Hunter's criteria. RESULTS: Six patients out of 50 lost to follow up and was removed from nal analysis . Out of 44 cases, mean age of patient was 34.77 year. Most of them 28(64%) were male. RTA was most common mode of injury 24(54%). Most of the patient 26(59%) had rd fracture on non dominant side. Majority of the fractures 24(55%) were in the middle 1/3 . Thirty two cases (72%) attended the hospital within 24 hours of injury. Union was achieved in 41(93%) patients within a mean time of 11.48 weeks. One transverse and two comminuted fractures in middle and distal third of diaphysis did not unite and were treated surgically. According to Hunter's criteria of evaluation of results, 31(75.6%) of united fractures had excellent (G5) and 10(24.4%) had good (G4) results. Restriction of few degrees of terminal range of movements of shoulder abduction and external rotation present initially improved subsequently after physiotherapy. Mean varus angulation in 39 patients at the time of removal of brace was 7.05° and mean valgus angulation in four patients was 6.00°. Mean anterior angulation of 6.85° was present in 21 patients and mean posterior angulation of 7.11° was present in 20 patients at the time of removal of brace. Mean shortening of 6.5 mm was present in 36 patients. The various angulation deformities and shortening at the end of union did not cause functional and cosmetic effect. Conclusion: Fracture shaft of humerus treated by close reduction and functional bracing has good functional outcomes.

scholarly journals Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

2016 ◽  
Vol 2 (3) ◽  
pp. 86
Author(s):  
Rajesh Govindasamy ◽  
Ramkumar Gnanasundaram ◽  
Saravanan Kasirajan ◽  
Fawas Thonikadavath ◽  
Jeff Walter Rajadurai
Keyword(s):  
Bone Grafting ◽  
Locking Compression Plate ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Functional Evaluation ◽  
Postoperative Function ◽  
Non Union ◽  
Humeral Shaft Nonunion ◽  
Compression Plate ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.</p><p class="abstract"><strong>Methods:</strong> Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22).  The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.</p><strong>Conclusions:</strong> LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

scholarly journals Managing Radial Nerve Injuries Associated with Humeral Fracture

2020 ◽  
Vol 71 (1) ◽  
pp. 400-404
Author(s):  
Vlad Carbunaru ◽  
Ana Maria Oproiu ◽  
Adrian Barbilian ◽  
Chen Feng-Ifrim ◽  
Alexandra Ciotei
Keyword(s):  
Nerve Injury ◽  
Radial Nerve ◽  
Nerve Palsy ◽  
Bone Fractures ◽  
Humeral Fracture ◽  
High Energy ◽  
Humeral Shaft ◽  
Long Bone ◽  
Radial Nerve Palsy ◽  
Radial Nerve Injury

The overall prevalence of radial nerve injury after humeral shaft fractures is up to 18% representing the most common peripheral nerve injury associated with long bone fractures. Spiral or oblique fractures of the junction between the middle and distal third of the humeral shaft are at greater risk for radial nerve injury. Iatrogenic damage to the radial nerve may also occur during manipulations of closed reduction. A prospective study between 2017-2019 following 5 patients (all male, with ages between 30 and 56 years old), who were treated at our clinic for complete radial nerve palsy after a high-energy fracture of the humerus. All the patients were followed-up for a mean of 6 months (range 4 - 15 months) post op. The first 3 cases showed the initial signs of recovery 4 weeks after the operation. In the last 2 cases a palliative radial intervention was required. The consequences of the radial nerve palsy associated with humeral fractures is strongly related to trauma mechanism. In high energy fractures, severe contusion or transection of the nerve must be expected. In this case, nerve recovery is unlikely and the patients should be informed of the poor prognosis and the need of tendon transfers.

Humeral shaft fracture and radial nerve palsy in Korean soldiers: focus on arm wrestling related injury

2020 ◽  
pp. jramc-2019-001373
Author(s):  
Kyoung-Eun Kim ◽  
E-J Kim ◽  
J Park ◽  
SW Kim ◽  
J Kwon ◽  
...  
Keyword(s):  
External Force ◽  
Military Service ◽  
Radial Nerve ◽  
Nerve Palsy ◽  
Humeral Fracture ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Humeral Shaft Fractures

IntroductionHumeral shaft fractures can lead to radial nerve injury and may require surgery and rehabilitation. We determined the causative events of humeral fracture, including arm wrestling, in young Korean soldiers and examined whether humeral fracture is related to demographic characteristics and the presence of radial nerve palsy.MethodsWe reviewed 7.5 years (July 2012 to June 2019) of medical records covering patients who had experienced a humeral shaft fracture after entering military service and had received surgery for open reduction and internal fixation. Data were obtained on basic demographics, initial event provoking the fracture, presence of radial nerve palsy, initial and follow-up severity of the weakness, and any discharge from military service because of prolonged radial nerve palsy.ResultsOf 123 cases, arm wrestling was the leading cause (52.8%). A high energy injury, such as falling from a height (11.4%), and sports related slips (10.6%) were other causes. All humeral shaft fractures caused by forceful contraction were spiral, while 40% of the fractures caused by external force related events were of a transverse type. The percentage of left-sided fractures was significantly higher for fractures arising from an external force than in those caused by forceful contraction related events. Radial nerve palsy was found in 34 patients (27.6%), and 16 were discharged from the military because of prolonged radial nerve palsy 6 months after the fracture. The causative events and other factors did not affect the presence of radial nerve palsy.ConclusionArm wrestling was the leading cause of humeral fracture in young Korean soldiers but the chance of developing comorbid radial nerve palsy did not differ from that of other causes. These epidemiologic findings in this young active group may help in understanding the causes of humeral shaft fracture in soldiers and in the wider young population.

Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures

2015 ◽  
Vol 24 (11) ◽  
pp. e307-e311 ◽  
Author(s):  
Femke M.A.P. Claessen ◽  
Rinne M. Peters ◽  
Diederik O. Verbeek ◽  
David L. Helfet ◽  
David Ring
Keyword(s):  
Operative Treatment ◽  
Radial Nerve ◽  
Nerve Palsy ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Factors Associated ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures

Throwing Fracture of the Humeral Shaft

1998 ◽  
Vol 26 (2) ◽  
pp. 242-246 ◽  
Author(s):  
Kiyohisa Ogawa ◽  
Atsushi Yoshida
Keyword(s):  
Nerve Palsy ◽  
External Rotation ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Baseball Player ◽  
Acceleration Phase ◽  
Baseball Players ◽  
Humeral Shaft Fractures ◽  
Proximal Half ◽  
Type Of Fracture

Ninety patients with humeral shaft fractures sustained during throwing were analyzed to determine what caused their injuries. All patients were recreational baseball players: 89 were men and 1 was a woman. The average age was 25 years (range, 12 to 43). The throwing style, type of pitch, fielding position, and type of ball used varied; however, the patients sustained their fractures while performing a hard throw in 87 (97%) of the occurrences. The actual courses of the balls thrown ranged from sideways to straight forward. All fractures were external rotation spiral fractures; 25 patients (28%) had a medial butterfly fragment, and 14 patients (16%) had radial nerve palsy. Fractures were most likely to have occurred in the distal half of the humerus, although they occurred frequently in the proximal half in patients in their early teens. We conclude that 1) the fracture can occur at any time during the acceleration phase before ball release, 2) this type of fracture can occur in any recreational baseball player attempting to perform a hard throw, and 3) the cause of this fracture is the throwing action itself.

Traumatic Brachial Plexus Palsy in Children: Long-Term Outcome and Strategy of Reconstruction

2021 ◽  
Author(s):  
Tarek A. El-Gammal ◽  
Amr El-Sayed ◽  
Mohamed M. Kotb ◽  
Waleed Riad Saleh ◽  
Yasser Farouk Ragheb ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Hand Function ◽  
Functional Restoration ◽  
Shoulder Abduction ◽  
Wrist Flexion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Age At Surgery ◽  
Flexion And Extension

Abstract Background Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Materials and Methods In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used. Results Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery. Conclusion Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.

scholarly journals Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Patrick Lee ◽  
Allison Z. Piatek ◽  
Michael J. DeRogatis ◽  
Paul S. Issack
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Open Reduction ◽  
Humeral Fracture ◽  
Humeral Shaft ◽  
Proximal Ulna ◽  
Elbow Injury ◽  
Anatomic Reduction ◽  
Elbow Injuries ◽  
Floating Elbow

“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

Clinical findings in C5-C6 and C5-C7 root palsies with brachial plexus traction lesions

2012 ◽  
Vol 38 (3) ◽  
pp. 237-241 ◽  
Author(s):  
J. A. Bertelli ◽  
M. F. Ghizoni
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Elbow Flexion ◽  
Clinical Findings ◽  
Hand Strength ◽  
Shoulder Abduction ◽  
Finger Extension ◽  
Root Injury ◽  
Flexion Extension

Stretch injuries of the C5-C7 roots of the brachial plexus traditionally have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. Based on current myotome maps we hypothesized that, as far as motion is concerned, palsies involving C5-C6 and C5-C7 root injuries should be similar. In 38 patients with upper-type palsies of the brachial plexus, we examined for correlations between clinical findings and root injury level, as documented by CT tomomyeloscan. Contrary to commonly held beliefs, C5-C7 root injuries were not associated with loss of extension of the elbow, wrist, thumb, or fingers, but residual hand strength was much lower with C5-C7 vs C5-C6 lesions.

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study

2008 ◽  
Vol 32 (2) ◽  
pp. 129-135 ◽  
Author(s):  
Suat Erel ◽  
İbrahim Engin Şimşek ◽  
Çiğdem Ayhan ◽  
Nilgün Bek ◽  
Yavuz Yakut ◽  
...  
Keyword(s):  
External Rotation ◽  
Operative Management ◽  
Shoulder Abduction ◽  
Rehabilitation Center ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Musculus Latissimus Dorsi ◽  
Obstetric Brachial Plexus ◽  
Teres Major ◽  
Preliminary Study

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 – 100° abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.

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