The surgical treatment of humeral shaft fractures

This is a study of 84 patients with upper arm fractures who were treated by plate osteosynthesis. The indication was mandatory in 9 patients with open fractures, 23 patients with primary radial nerve palsy on admission, 5 patients with radial nerve palsy after the initial treatment, 22 patients with pseudarthrosis and 7 patients who were polytraumatised. The operation was also indicated in 15 patients, because of the form of the fracture, in 3 patients with brachial plexus lesion, in 3 patients because it involved both upper arms and in 3 patients with segmental fractures. The 4.5 DCP was used in all these cases. All the cases of pseudarthrosis progressed to achieve bony union after the operation. There was no incidence of postoperative pseudarthrosis. We did encounter two cases (2.4%) of radial nerve palsy that required exploration. All the preoperative primary and secondary cases of radial nerve palsy recovered postoperatively. After an average follow-up period of 2.4 years (1-10 years) 90% of the patients could be classified as having very good or good results.     

Primary surgical treatment of humeral shaft fractures

Primary internal fixation of acute humeral shaft fractures is only seldom indicated. Following the late results, indication and technique must be very strict. This is shown by the number of 37 cases in seven years and the very low complication rate.     

Functional treatment of closed humeral shaft fractures

We treated 93 consecutive patients, average age 53 (16–90) years, with closed humeral shaft fractures applying a functional brace immediately after injury. Seventy-two (77%) fractures healed without problems. There were significantly more consolidation problems in fractures in the proximal third (46% consolidated) compared to those at the middle (81% consolidated) and distal third (86% consolidated) of the shaft. Logistic regression analysis revealed the only predictive factor in respect to successful brace treatment was fracture location. No significant difference was found in respect to healing between different AO-type fractures.

---

Résumé Nous avons traité 93 malades consécutifs, dâge moyen 53 ans (16–90), avec une fracture diaphysaire humérale fermée en utilisant une attelle fonctionnelle immédiatement après le traumatisme. Soixante-douze (77%) fractures ont guéri sans problème. Il y avait plus de difficultés de consolidation dans les fractures du tiers proximal (46% ont consolidé) comparé à celles du tiers moyen (81% ont consolidé) et du tiers distal (86% ont consolidé) de la diaphyse. Lanalyse statistique a révélé que le seul facteur prédictif de la réussite du traitement est la localisation de la fracture. Aucune différence significative na été trouvée selon les types de la classification AO.

     

锁定钢板治疗肱骨干骨折

2008年11月～2011年1月,我院采用锁定钢板治疗肱骨干骨折22例,均获得满意疗效,报道如下。1材料与方法1.1病例资料本组22例,男11例,女11例,年龄19～78岁;其中19～40岁13例,60～78岁9例。均为急性损伤。骨折按AO分型:12-A1型3例,12-     

双钢板治疗肱骨干骨折的疗效

目的总结双钢板治疗肱骨干骨折的临床疗效。方法采用双钢板治疗28例肱骨干骨折患者。记录手术时间、术中出血量、骨折愈合时间及并发症发生情况,采用Mayo肘关节功能评分、UCLA肩关节功能评分评价肩肘关节功能。结果手术时间57~94 min,术中出血量55~220 ml。患者均获得12个月随访。骨折愈合时间3~5个月。术后12个月,Mayo肘关节功能评分为85~95分,肩关节功能UCLA评分优良率为26/28。2例发生并发症,经治疗后愈合。结论双钢板治疗肱骨干骨折固定牢靠,有利于骨折快速愈合,且术后并发症较少,关节功能恢复良好。     

Operative treatment of humeral shaft fractures. The Leuven experience

For many years, plating has proved to be a reliable method for the fixation of fractures of the humeral shaft. In the early nineties however, intramedullary devices became increasingly popular for fractures of the humeral shaft. This was based on a global tendency towards minimally invasive surgery, and the attractiveness of the relatively simple procedure and potentially lower complication rate of intramedullary nailing, which had proved to be successful in osteosynthesis of the lower limb, However, until now there is no consensus in the literature as to which device is preferable for different indications. We reviewed 161 patients, operatively treated for a fracture of the humeral shaft in our department between 1986 and 1999. Our experience shows in most indications a higher union rate, better functional results and a lower reoperation rate after plate and screw fixation. In addition, even though plating requires a more technically demanding procedure, in experienced hands, it gave rise to fewer iatrogenic fractures, and fewer persisting pain problems. We recommend the use of plate and screws as primary treatment in all operative indications, except for pathological fractures, very obese patients, and open fractures.     

Results of non-operative and operative treatment of humeral shaft fractures. A series of 104 cases

The aim of this study was to examine the results of different modalities applied in the treatment of 104 fresh diaphyseal fractures of the adult humerus treated in the department between January 1994 and March 1997. These results were classified according to the criteria described by Stewart and Hundley. 32 patients (30.8%) were treated non-operatively using a sling and a moulded plaster splint. The type of treatment had to be changed in 12 of these patients due to 14 different complications that occurred during the course of non-operative treatment. Thus, 20 patients (62.5%) underwent non-operative treatment until fracture-union. The results in this group were: very good in 12 cases (60%), good in 5 cases (25%), fair in 3 cases (15%). 28 fractures were treated using plates and screws. 4 events (14%) occurred during in the post-operative period and, apart from 2 cases of non-union, the overall result in the 26 patients in whom the fracture united was: very good in 23 cases (88.5%) and good in 3 cases (11.5%). 22 patients (21.1%) underwent fixation using multiple flexible intramedullary wires via a supracondylar approach. Apart from one case of non-union, the final result in the 21 patients in whom the fracture united was: very good in 9 cases (42.8%), good in 9 cases (42.8%), fair in 2 cases (9.5%) and poor in 1 case (4.9%). 22 fractures were treated using an intramedullary Seidel nail. The final result in these patients was: very good in 11 cases (50%), good in 9 cases (41%) and poor in 2 cases (9%). The indications for treatment should be eclectic. Non-operative treatment remains the method of choice for undisplaced or minimally-displaced fractures or comminuted fractures with multiple parallel longitudinal fracture-lines over the middle-third, while surgical treatment is considered for displaced fractures and essentially depends upon the type and level of the fracture. Transverse and short oblique fractures are treated using a plate or a Seidel nail. Fractures with a third fragment require plate osteosynthesis. Multiple flexible intramedullary wires are used for segmental fractures or for diaphyseal fractures associated with fractures of the neck of the humerus. Comminuted fractures are realigned using an intramedullary Seidel nail or multiple flexible wires. As far as the site of fracture is concerned, those of the proximal and middle thirds of the humerus are well treated using an intramedullary nail or multiple wires or with a plate, while plating is most often the method of choice for fractures of the distal-third.     

Management of humeral shaft fractures

Humeral shaft fractures account for approximately 3% of all fractures. Nonsurgical management of humeral shaft fractures with functional bracing gained popularity in the 1970s, and this method is arguably the standard of care for these fractures. Still, surgical management is indicated in certain situations, including polytraumatic injuries, open fractures, vascular injury, ipsilateral articular fractures, floating elbow injuries, and fractures that fail nonsurgical management. Surgical options include external fixation, open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and antegrade or retrograde intramedullary nailing. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. However, good surgical outcomes can be achieved with proper patient selection.     

肱骨干骨折内固定的选择及应注意的问题

目的正确选择肱骨干骨折手术内固定.方法对107例肱骨干骨折分别进行交锁髓内钉(34例)、加压钢板(29例)、Y型钢板(38例)、螺钉(6例)等内固定,并随访比较分析. 结果所有病例均得到随访,平均随访6.3个月.交锁髓内钉、螺钉内固定组全部愈合;加压钢板内固定组愈合26例,伴桡神经损伤2例;Y型钢板内固定组全部愈合,伴肘关节僵硬2例. 结论根据肱骨干骨折的部位和类型选用适当的内固定方法,骨折愈合良好,可有效的减少并发症的发生.     

粉碎性肱骨近端骨折的手术治疗体会

[目的]探讨粉碎性肱骨近端骨折的治疗体会及经验。[方法]对30例（次）粉碎性肱骨近端骨折采用切开复位，T形或三叶形钢板内固定的方法，并分析疗效。[结果]平均骨折愈合时间术后22周。有1例病人出现肱骨头坏死。有1例病人于术后出现伤口感染，经治疗后未影响骨折愈合。肩关节功能：优，11例；良，14例；可，4例；差，1例。优良率86．3％。[结论]对于粉碎型肱骨近端骨折采用切开复位钢板内固定的方法来治疗有良好的效果。术中强调肱骨大结节（岗上肌止点）的修复或重建，和对于腋神经的保护。     

Functional treatment of the distal third humeral shaft fractures

OBJECTIVE: The objective of the present study was to determine the effectiveness of functional treatment for distal third humeral shaft fractures in young adults. PATIENTS AND METHODS: A custom-made prefabricated brace was applied for the functional treatment of 21 isolated, closed, distal third humeral shaft fractures of 21 patients (17 male and 4 female). Their average age was 25 years (range 18-37 years). The mean follow-up period was 39 weeks. RESULTS: All of the fractures united. The average time to union was 12 weeks. The average varus angulation was 7.8 deg in 8 patients, and the average shortening of the fractured limb was 10 mm in 4 patients. Minimal motion restrictions mostly occurred in shoulder abduction and lateral rotation. No patient showed a lack of elbow motion. Angulatory deformities and shortening had no effect on the functional outcome. None of the patients suffered radial nerve palsy during the course of treatment or due to entrapment in the callus of the healed fracture. CONCLUSIONS: Young adults who have isolated, closed, distal third humeral shaft fractures are good candidates for functional bracing.     

Pulmonary embolism after operative treatment of proximal humeral fractures

There have been multiple studies on the prevalence of pulmonary embolism, the probability of death from a pulmonary embolism, and the risk factors for the development of pulmonary embolism after lower extremity and pelvic trauma. However, there is no information on the risk of pulmonary embolism after the surgical management of proximal humeral fractures. A review of 137 consecutive patients who underwent operative treatment for acute, isolated proximal humeral fractures at our institution between January 1, 1998, and December 31, 2003, was performed to identify all who sustained a pulmonary embolism. Postoperatively, 7 patients sustained a pulmonary embolism that was confirmed by computed tomography. Of these, 4 had been treated with a hemiarthroplasty and 3 had undergone open reduction-internal fixation. The overall incidence of pulmonary embolism in this series was 5.1%. None of the patients sustained a fatal pulmonary embolus. These data suggest that the rate of pulmonary embolism after operative treatment of proximal humeral fractures is not low. This study raises the question of whether prophylactic anticoagulation is needed after routine proximal humeral repair.