Acute Operative Management of Humeral Shaft Fractures: Analysis of the National Trauma Data Bank

Introduction Indications for surgical management of displaced humeral shaft fractures are not clearly established, leading to variations in practice. The aim of this study was to determine the scale of these variations in the UK practice to help design a future national trial. Methods An online survey was sent to all surgeon members of British Elbow and Shoulder Society to help define humeral shaft fractures, fracture displacement as well as indications for operative and non-operative management. Patient and injury related factors considered important when managing humeral shaft fractures were investigated. Results The survey achieved a response rate of 32% (104/327). There was a lack of consensus on definitions for humeral shaft fractures and fracture displacement. A functional brace was the most common form of non-operative treatment (63%). Majority immobilise humeral shaft fractures for 4–8 weeks or until callus are visible (62%) with a similar number considering operative treatment if adequate signs of healing are not present at around 12–16 weeks. Around half of our respondents exclusively use plates with variations in preference of approach and a minority (2%) exclusively use intra-medullary nails. Conclusion The significant variation in management of displaced humeral shaft fractures in the UK suggests a clear need to evaluate clinical and cost effectiveness through a multi-centre randomised trial.

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Operative management of pediatric humeral shaft fractures

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i1j.100 ◽

2017 ◽

Vol 3 (1j) ◽

pp. 672-674

Author(s):

Dr. Virupaksha Reddy ◽

Dr. Sanjeev Chincholi

Keyword(s):

Operative Management ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173656 ◽

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

Background: 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.Methods: 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.Results: 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. Conclusions: 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.

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Iatrogenic Radial Nerve Palsy After Operative Management of Humeral Shaft Fractures

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31816142cf ◽

2009 ◽

Vol 66 (3) ◽

pp. 800-803 ◽

Cited By ~ 53

Author(s):

Jung-Pan Wang ◽

Wun-Jer Shen ◽

Wei-Ming Chen ◽

Ching-Kuei Huang ◽

Young-Shung Shen ◽

...

Keyword(s):

Radial Nerve ◽

Nerve Palsy ◽

Operative Management ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Humeral Shaft Fractures ◽

Shaft Fractures

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Operative versus non-operative treatment of humeral shaft fractures: A systematic review

Shoulder & Elbow ◽

10.1177/1758573218825477 ◽

2019 ◽

Vol 12 (4) ◽

pp. 229-242

Author(s):

Harry William Sargeant ◽

Luke Farrow ◽

Scott Barker ◽

Kapil Kumar

Keyword(s):

Operative Treatment ◽

Plate Fixation ◽

Meta Analysis ◽

Operative Management ◽

Delayed Union ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Iatrogenic Nerve Injury ◽

Non Operative Management

Background Humeral shaft fractures are common but debate still occurs as to whether these are best managed operatively or non-operatively. We sought to undertake a systematic review and meta-analysis of randomised and non-randomised studies to clarify the optimal treatment. Methods We performed a search for all randomised and non-randomised comparative studies on humeral shaft fracture. We included only those with an operative and non-operative cohort in adult patients. We undertook a meta-analysis of the following outcome measures: nonunion, malunion, delayed union, iatrogenic nerve injury and infection. Non-operative management was with a functional brace. Results Non-operative management resulted in a significantly higher nonunion rate of 17.6% compared to 6.3% with fixation. Operative management had a significantly higher iatrogenic nerve injury rate of 3.4% and infection rate of 3.7%. All nonunions within the included studies went on to union after plate fixation. There was no significant difference in delayed union or patient reported outcome measures. There was a significantly increased risk of malunion with non-operative treatment however this did not correlate with the outcome. Discussion Our findings suggest that in the majority of cases, humeral shaft fractures can be managed with non-operative treatment, and any subsequent nonunion should be treated with plate fixation.

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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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