Outcome of Dynamic Compression Plate versus Interlock Intramedullary Nail for Management of Humeral Shaft Fractures

Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted post-operative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group. Keywords: Humerus shaft fractures, dynamic compression plates, interlocking intramedullary nailing.

Postoperative malrotation of humerus shaft fracture causes degeneration of rotator cuff and cartilage

We hypothesized that postoperative malrotation of humeral shaft fractures can alter the bio-mechanical environment of the shoulder; thus, rotator cuff and cartilage degeneration could be induced. Therefore, we designed an animal experiment to evaluate the impact of malrotation deformities after minimally invasive surgery for humeral fractures on the rotator cuff and cartilage, which has rarely been described in previous studies. Twenty-four New Zealand white rabbits were randomly divided into the sham control group (A), negative control group (B) and malrotated group (C). A sham operation with surgical exposure alone was performed in group A. Humeral shaft osteotomy was performed in Group B and C. In Group B, the fractures were fixed in situ with plate -screw system. While in Group C, iatrogenic rotational deformity was created after the proximal end of the fracture being internally rotated by 20 degrees and then subsequently fixed. The animals with bone healing were sacrificed for pathological and biochemical examination. In group C, the modified Mankin scale for cartilage pathology evaluation and the modified Movin scale for tendon both showed highest score among groups with statistical significance (P < 0.05); Disordered alignment and proportion of collagen I/III of rotator cuff were confirmed with picrosirius red staining; Transmission electron microscopy also showed ultrastructural tendon damage. Immunohistochemistry showed that both MMP-1 and MMP-13 expression were significantly higher in group C than groups A and B(P < 0.05). Minimally invasive techniques for humerus shaft fracture might be cosmetically advantageous, but the consequent postoperative malrotation could increase the risk of rotator cuff and cartilage degeneration. This conclusion is supported here by primary evidence from animal experiments.

A Case Report of Humerus Shaft Osteomyelitis Secondary to Local Skin Infection Treated with Saucerization.

Introduction:Osteomyelitis of the humerus shaft after local skin infection is rare clinical entity, all the principles of tibia and femur osteomyelitis are used in the humerus osteomyelitis. Early detection is best done by the magnetic resonance imaging. Surgical debridement and curettage with IV antibiotics gives good clinical outcome in the patient. Case Report:A 35-year-old female presented with discharging sinus over posterior aspect of the humerus for 1 year. Diagnosis done based on X-ray and clinical examination. The patient managed with local debridement and saucerization, on follow-up patient is doing all the daily activities and no sign of recurrence at 18 months post-operative. Conclusion:Local debridement saucerization and course of IV antibiotics according to culture sensitivity give good clinical outcome in cases of humerus osteomyelitis. Keywords:Humerus, osteomyelitis, bone infections, saucerization, antibiotics.

A PROSPECTIVE FOLLOW UP STUDY OF EVALUATION OF SHOULDER FUNCTION AFTER ANTEGRADE INTERLOCKING NAILING IN HUMERUS SHAFT FRACTURES IN ADULTS

INTRODUCTION: This study was conducted to assess the shoulder function after antegrade interlocking humerus nailing in humerus shaft fractures, duration of union, complications (immediate and late) of this xation. METHODS: In this prospective study 40 cases with humerus shaft fractures were treated with antegrade interlocking humerus nailing and followed up for functional outcomes and complications. RESULTS: The age of patients ranged from 18 to 57 years. The assessment of shoulder function was made according to CONSTANT score. Out of 40 patients shoulder function was excellent in 35 cases (87.5%), very good in 3 cases (7.5%) and fair in 1 case (2.5%). Period of fracture union ranged from 12 to 18 weeks, average period being 13.7 weeks. None had iatrogenic radial nerve injury and/or infection. CONCLUSION: We concluded that Locked intramedullary nailing is a novel treatment option for diaphyseal fractures of the humerus. By making correct entry, repairing rotator cuff, placing the nail inside proximal end and proper physiotherapy; shoulder function outcome can be improved to excellent in cases of humerus diaphyseal fractures treated with antegrade interlocking humerus nailing.

Fracture of the humerus in arm wrestling: An uncommon mechanism for a common fracture

A case of a healthy young patient which had a spiral fracture of humerus shaft during an arm-wrestling game. Various differential diagnosis should be assessed. Treatment is the same as a fracture of humerus shaft from any other mechanism.

EXPERIENCES OF SURGICAL MANAGEMENT OF FRACTURE SHAFT OF HUMERUS IN ADULTS USING ENDER NAIL

Background: This study was conducted at the Department of Orthopaedics, I.P.G.M.E& R & SSKM Hospital, Kolkata, West Bengal, with the objective to achieve quick union and minimal soft tissue disruption, least neurovascular complications and good functional outcome. In this study, 30 patients were selected on random basis from those attending the Outpatient Department and Emergency Room, between January 2015 to August 2016, with humerus shaft fractures. Among these, 76% of the patients were in age group (<40 years) with age range 22-60 years with mean age 35 years .The male : female ratio was 6.7:1 . In our study majority (73%) of the patients have type AO 12A3 fracture .Mean duration of injury was 9.633 days. Mean duration of surgery in our study was 74.33 minutes, with range of 45-95 minutes, indicating a short operating time and minimum radiation exposure. During intraoperative period no complications and difficulties were experienced. The complications of our operative period were only 13%. Mean duration of follow up was 13.7 months with range from 9-18 months without any no loss at follow up. All fractures united. Mean duration of union was 17 weeks. In this study, 80% patients had excellent grading, 17% have good grading and 3% had fair grading on the basis of MEPS and UCLA score combining shoulder and elbow functional outcome .In the present study, we dealt with the association of different parameters with respect to grading fracture pattern and type .This study showed that Ender’s nailing for closed humerus shaft fracture provided satisfactory clinical ,radiological, and functional outcome ,was minimally invasive ,had less infection rate and least neurovascular complications, thus promising a viable option for treatment of closed shaft humerus fracture. Keywords: Closed fracture shaft Of humerus ; Adults, Minimally invasive , Ender’s Nail ; Fracture union.