Surgical vs. Nonsurgical Management for Humeral Shaft Fractures; Preference Among Orthopaedic Surgeons

2021 ◽  
Vol 23 (1) ◽  
pp. 21-26
Author(s):  
Tariq A. Kwaees ◽  
Nasri H. Zreik ◽  
Charalambos P. Charalambous
Keyword(s):  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Benefit Design ◽  
Electronic Survey ◽  
Humeral Shaft Fractures ◽  
Nonsurgical Management ◽  
Shaft Fractures ◽  
Diaphyseal Fractures

Background. Determining trends in managing humeral shaft fractures may help identify variation in practice which might benefit design of clinical guidance. We aimed to determine the practice of members of the British Elbow and Shoulder Society (BESS) in managing humeral shaft fractures. Methods and materials. An electronic survey was sent to members of BESS. Questions related to preferred surgical and nonsurgical approaches for management of humeral shaft fractures. This was divided into management of proximal, middle and distal third diaphyseal fractures. Results. 91 fully completed responses were analysed. Nonsurgical management was preferred by 90.1% (n=82) for middle-third and 80.2 % (n=73) for proximal third fractures but there was an almost even split in favouring surgical (52.7%, n=48) and nonsurgical (42.8%, n=39) treatment for distal third fractures. There was great variation in how to deal with a humeral shaft fracture associated with radial nerve palsy with an almost equal divide between those favouring a surgical and nonsurgical approach for mid-shaft or distal third fractures. Conclusions. 1. The management preference for humeral shaft fractures amongst surgeons is highly variable. 2. This may be partly attributed to the sparsity of high-quality evidence. 3. Well-designed randomised trials or pro­spective cohort studies may help further guide management of these injuries.

HEALING PATTERN OF INTERLOCKED INTRAMEDULLARY NAILED HUMERAL SHAFT FRACTURE

2016 ◽  
Vol 19 (04) ◽  
pp. 1650018
Author(s):  
Myung-Sang Moon ◽  
Dong-Hyeon Kim ◽  
Min-Geun Yoon ◽  
Sang-Yup Lee
Keyword(s):  
Bone Fractures ◽  
Weight Bearing ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Long Bone ◽  
Patients Âgés ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Entry Points

Design: Study on the cases of the united interlocked intramedullary (IM) nailed humeral shaft fractures. Objective: To assess the healing pattern of nailed humeral shaft fracture and to compare it with the results of the other previous authors’ nail-treated large bone fractures. Background data: Based on the relevant previous studies related with healing patterns of the interlocked IM nail-managed humeral shaft fractures, the current age-matched study on the participating callus for union was conceived. The comparative study on the healing patterns between the fractures of non-weight-bearing long bone — the humerus — and other large weight-bearing long bones have never been carried out previously. Materials and methods: Eighty-nine cases of the humeral shaft fractures, fixated with antegrade interlocked IM standard Kuentscher nail were subjected to the study. The patients’ ages ranged from the late teens to 9th decade of life. For the antegrade nailing, two entry points were chosen; conventional entry point in the early series, and rotator cuff interval in the late series. Results: External callus was very rarely formed [12 cases (13.4%)]. It was formed at post-fixation 6.5 weeks on average in cases with unreduced displaced fragment, and proximal interlocking. Radiographic union occurred at post-fixation 17.6 weeks on an average by primary osteonal callus. Conclusion: It was concluded that in most cases union was obtained primarily by the contact or gap healing irrespective of the patients’ ages, and that periosteal participation was very rare or negligible. Use of smaller diameter nail or new development of less rigid IM nail without external nail shape change is thought desirable to induce periosteal callus in early healing stage.

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.

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.

scholarly journals A Comparative Study on Internal Fixation Using Long Proximal Intramedullary Nail for the Treatment of Humeral Shaft Fracture according to Fracture Types

2019 ◽  
Vol 22 (2) ◽  
pp. 87-92
Author(s):  
Chang-Hyuk Choi ◽  
Chung-Mu Jun ◽  
Jun-Young Kim
Keyword(s):  
Internal Fixation ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Optimal Choice ◽  
Humeral Shaft ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
Group I ◽  
The Mean ◽  
Group Ii

Background: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types.Methods: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft f?r Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20?87 years), and mean follow-up period was 2.3 years (range, 1.0?6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed.Results: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (<i>p</i><0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (<i>p</i>=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (<i>p</i>=0.352).Conclusions: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

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. 

scholarly journals Humeral shaft fracture associated with radial nerve palsy -a case report

2021 ◽  
pp. 54-55
Author(s):  
Rishitha M ◽  
Akasha Sindhu M
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Wrist Joint ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Loss Of Function ◽  
History Of ◽  
The Right

Radial nerve palsy was induced by radial nerve compression, which was often caused by humerus bone fracture. This leads to pain, weakness, or loss of function mostly in the wrist, hand, and fingers. We reported a case of a 24-year-old male patient with complaints of swelling of the right-hand wrist joint and pain during extension and flexion while moving. He had a three-month history of mild displaced humeral shaft fracture from a traffic accident and an intramedullary Ender nailing was performed. He now has been admitted with swelling in his right wrist joint and pain while moving his hand. The case was diagnosed as Radial nerve palsy. Surgery was performed, the proximal and distal ends of the radial nerve were separated at the humeral bone's surface. The radial nerve stumps were enough long to be sutured. Our one-month follow-up shows no complications. The majority cases of radial nerve palsy will resolve within a few weeks after surgery, as our patient did, and the most prominent is patient education.

A Clinical Study of the Radial Nerve Palsy Associated with Humeral Shaft Fractures

1992 ◽  
Vol 27 (1) ◽  
pp. 181
Author(s):  
Sung Joon Kim ◽  
Tai Seung Kim ◽  
Kwang Hyun Lee ◽  
Do Gyoung Lee ◽  
Byoung Suck Kim
Keyword(s):  
Clinical Study ◽  
Radial Nerve ◽  
Nerve Palsy ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures
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