Treatment outcomes in humeral fractures of different location (review)

The choice of treatment (open reduction and internal fixation) for a humeral fracture with a plate versus an intramedullary nail is highly debated. We compared outcomes (fracture union, reoperation, and adverse events) of intramedullary nailing and plate fixation in patients with proximal humeral, humeral shaft, and distal humeral fractures. No significant differences were found between intramedullary nailing and plate fixation for fracture union, reoperation, or adverse events in patients with proximal humeral or humeral shaft fractures. There is a scarcity of evidence comparing intramedullary nailing and plating for distal humeral fractures. No recommendations can be given from current evidence. Surgeons may have to continue to use discretion based on their personal preference, experience as well as patient’s characteristics and fracture features before more high-quality evidence is available.

Unipolar Latissimus Dorsi Transfer for Restoration of Elbow Flexion in Residual Post-traumatic Brachial Plexus Palsy Associated with Distal Humeral Fractures

Introduction Elbow flexion is indispensable for both functioning and nonfunctioning hands. It is well perceived that restoration of elbow function is the first reconstructive priority in cases of brachial plexus injuries. The authors assessed the impact of associated distal humeral fractures on the functional outcome after unipolar latissimus dorsi transfer (ULDT) for restoration of elbow flexion in patients with residual brachial plexus palsy (BPP). Patients and Methods Twenty-three patients operated for restoring elbow flexion after residual post-traumatic BPP (with or without distal humeral fracture) by unipolar latissimus dorsi transfer (ULDT) were reviewed for a retrospective study. Patients were divided into two groups; associated distal humeral fracture group (HF-group; 10 patients) and non-associated distal humeral fracture group (NHF-group; 13 patients). Elbow flexion active range of motion (AROM), flexion deformity in addition to Mayo Elbow Performance Score (MEPS) were assessed. Results In both groups there were statistically better postoperative MEPS grading (p = 0.007, p = 0.001, respectively) and scoring with a mean of 81 ± 16.1 and 90 ± 4.6, respectively (p < 0.001). The mean postoperative elbow flexion AROM was statistically better in both groups. The mean supination AROM was better in NHF group (p = 0.057). Conclusion The use of ULDT in residual post-traumatic BPP is an efficient procedure in regaining functional flexion and supination. An associated distal humeral fracture does not significantly affect the final functional outcome. Level of Evidence Level IV.

INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT

Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.

OUTCOMES IN DOUBLE TENSION BAND OSTEOSYNTHESIS IN DISTAL HUMERUS FRACTURES AO TYPE C1

Introduction: Distal humeral fractures accounts for approximately 2% of all fractures and nearly onethird of humeral fractures in adults. In this regard, Double Tension Band Wiring (DTBW) technique was used for the xation of the distal humeral fractures type C1 (AO) to evaluate the early movement and complications of the patients. Methodology: This study was conducted on 38 patients of C1 (AO type)who were subjected to open reduction and internal xation using DTBW techniques, to evaluate the incidence of complications and to evaluate intraoperative parameters and postoperative functional outcomes over a period of 12 months. Results: The mean age of the participants was 43.7 years. The mean tourniquet time was 76 minutes. The mean union time was 11.4 weeks and the mean duration of the follow-ups was 13.72 months. The mean values for the lack of extension, exion, and range of motion were 12.24o, 120.9o, and 108.2o respectively. Neuropraxia was observed in 1 patient who was treated with conservative treatment. Mean MEPS score was 80.15. 17 patients had excellent scores , 12 had good scores and 9 had fair scores. None had poor scores. Hardware prominence was observed in 1 case which was treated with hardware removal after union was achieved. Hardware removal was performed 6 months after the surgery. Moreover, patients were diagnosed with no serious complications, such as the nonunion of fracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of their treatment. Conclusions: Based on the obtained results, it can be concluded that DTBW is an effective technique in AO type C1 fracture xation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration, tourniquet time, and damage caused by soft tissue stripping.