scholarly journals A Unique Complication after a Routine Operation – Late Pseudoaneurysm of the Brachial Artery after Plate Fixation of Humeral Shaft Fracture. A Case Report and Review of the Literature

Folia Medica ◽  
2020 ◽  
Vol 62 (3) ◽  
pp. 610-614
Author(s):  
Boris Kyurkchiev ◽  
Borislav Zlatev ◽  
Todor Georgiev ◽  
Dian Enchev
Keyword(s):  
Brachial Artery ◽  
Rare Case ◽  
Proximal Humerus ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Orthopedic Implants ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Review Of The Literature ◽  
Attending Physician

We report an extremely rare case of an 82-year-old woman with pseudoaneurysm of the brachial artery developed 22 months after a plate osteosynthesis with angularly stable locking plates for the proximal humerus. The condition was initially misdiagnosed as a tumor by the attending physician, and the patient was referred to an oncological unit. The case was successfully managed by a multidisciplinary team consisting of orthopedic and vascular surgeons. An up-to-date review of the available literature is also provided. The pseudo-aneurysms of the axillary and the distal peripheral arteries of the upper limb are a rare but potentially dangerous complication because the thromboembolism could lead to gangrene and amputation of the extremity. Despite casuistic, they should be taken into consideration in the differential diagnosis after plate osteosynthesis. Proper operative technique and constant vigilance when orthopedic implants are used are of paramount importance, which is actually the emphasis of this report.

Beware the rebound effect: regional anesthesia increases opioid utilization after humerus fracture surgery

2021 ◽  
pp. 175857322110481
Author(s):  
Daniel J. Cunningham ◽  
Micaela A. LaRose ◽  
Gloria X. Zhang ◽  
Ariana R. Paniagua ◽  
Christopher S. Klifto ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Proximal Humerus ◽  
Rebound Effect ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Opioid Consumption ◽  
Humeral Shaft ◽  
Patients Âgés ◽  
The Impact ◽  
Fracture Surgery

Introduction Regional anesthesia (RA) is used reduce pain in proximal humerus and humeral shaft fracture surgery. The study hypothesis was that RA would decrease opioid demand in patients undergoing fracture surgery. Materials and methods Opioid demand was recorded in all patients ages 18 and older undergoing proximal humerus or humeral shaft fracture surgery at a single, Level I trauma center from 7/2013 – 7/2018 (n = 380 patients). Inpatient opioid consumption from 0–24, 24–48, and 48–72 h and outpatient opioid demand from 1-month pre-operative to 90-days post-operative were converted to oxycodone 5-mg equivalents (OE's). Unadjusted and adjusted models were constructed to evaluate the impact of RA and other factors on opioid utilization. Results Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.8 estimated OE's without RA vs 8.8 estimated OE's with RA from 0–24 h post-op; 10 vs 13.7 from 24–48 h post-op; and 8.7 vs 11.6 from 48–72 h post-op; all p < 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at all timepoints. Discussion In proximal humerus and humeral shaft fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics.

Treatment of Brachial Artery Injury with Humeral Shaft Fracture Using Endovascular Stenting

2010 ◽  
Vol 45 (6) ◽  
pp. 490
Author(s):  
Suk Kang ◽  
Phil-Hyun Chung ◽  
Chung-Soo Whang ◽  
Jong-Pil Kim ◽  
Young-Sung Kim ◽  
...  
Keyword(s):  
Brachial Artery ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Endovascular Stenting ◽  
Artery Injury

scholarly journals Humeral shaft fracture: a randomized controlled trial of nonoperative versus operative management (plate fixation)

2019 ◽  
Vol Volume 11 ◽  
pp. 141-147
Author(s):  
Seyed Mahdi Hosseini Khameneh ◽  
Mohammadreza Abbasian ◽  
Hashem Abrishamkarzadeh ◽  
Shahab Bagheri ◽  
Fahimeh Abdollahimajd ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Plate Fixation ◽  
Operative Management ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Randomized Controlled

A Comparison of Plate Fixation with Intramedullary Nailing in Humeral Shaft Fracture

1997 ◽  
Vol 10 (4) ◽  
pp. 785
Author(s):  
Kwang Won Lee ◽  
Kyou Hyeun Kim ◽  
Ha Yong Kim ◽  
Young Sik Min ◽  
Hwan Jung Kim ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Plate Fixation ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft

scholarly journals Secondary Radial Nerve Palsy after Minimally Invasive Plate Osteosynthesis of a Distal Humeral Shaft Fracture

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ursina Bichsel ◽  
Richard Walter Nyffeler
Keyword(s):  
Minimally Invasive ◽  
Radial Nerve ◽  
Nerve Palsy ◽  
Plate Osteosynthesis ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Short Time

Minimally invasive plate osteosynthesis is a widely used procedure for the treatment of fractures of the femur and the tibia. For a short time it is also used for the treatment of humeral shaft fractures. Among other advantages, the ambassadors of this technique emphasize the lower risk of nerve injuries when compared to open reduction and internal fixation. We report the case of secondary radial nerve palsy caused by percutaneous fixation of a plate above the antecubital fold. The nerve did not recover and the patient needed a tendon transfer to regain active extension of the fingers. This case points to the importance of adequate exposure of the bone and plate if a humeral shaft fracture extends far distally.

scholarly journals Treatment of midshaft clavicle fracture with anatomical contoured clavicular locking plate

2018 ◽  
Vol 10 (1) ◽  
pp. 92-96
Author(s):  
Pratyenta Raj Onta ◽  
Krishna Sapkota ◽  
Krishna Wahegaonkar ◽  
Niraj Ranjeet ◽  
Pabin Thapa ◽  
...  
Keyword(s):  
Shoulder Joint ◽  
Open Reduction ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Shaft Fracture ◽  
Free Movement ◽  
Early Return ◽  
The Mean

Background: Fracture clavicle is a common fracture around the shoulder joint accounting about 2.6% of all fracture and 44% in shoulder region. Mid shaft clavicle fracture accounts about 81% of total clavicle fracture. Open reduction and plate fixation is a good treatment method for displaced mid shaft clavicle fracture with benefit of early pain free movement of shoulder joint and early return to work. The anatomical contoured clavicular plate maintains mechanical strength and has less soft tissue complications. Aims and Objective: The aim of the study was to evaluate the clinical and radiological outcome, time for fracture union and complications in midshaft clavicle fracture managed with anatomical contoured clavicularlocking plate. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal.There were a total of 30 patients (19 male and 11 female) who had displaced mid shaft fracture. All patients underwent plate osteosynthesis with anatomical contoured locking plate. The patients were followed up at 3 weeks, 6 weeks, 3 month and 6 months’ time. Results: There were 30 patients among whom; one patient had bilateral clavicle fracture. The mean age of the patient was 37.19 (11.96) years. The mean time for clinical and radiological union was 8.77 (1.17) weeks and 17.03 (3.06) weeks. All patients in our study had union of fracture with only one patient having superficial surgical site infection. Conclusion: Open reduction and plate fixation is a good option for displaced mid shaft clavicle fracture which help the patient for early pain-free movement of shoulder. Use of anatomical contoured clavicle plate provides fixation of clavicle to its normal contour and provides better fixation and stability.  

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.

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