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Fu G, Zhang Y, Ke S, Zhu D, Wu J, Su D, Ge H, Chen J, MB YZ, Lin F, Chen J, Li R. Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis. Orthop Surg 2023; 15:3101-3107. [PMID: 37817420 PMCID: PMC10693993 DOI: 10.1111/os.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. METHODS The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. RESULTS There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). CONCLUSION A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.
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Affiliation(s)
- Gang Fu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Yichong Zhang
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Shuyujiong Ke
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Dengke Zhu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jingxiang Wu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Dengbang Su
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Hui Ge
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jianlong Chen
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Yan Zhang MB
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jianhai Chen
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Renbin Li
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
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Yang J, Yang Z, Liu D, Lu Z, Tao C, Liu T. Is an anteromedial minimally invasive approach for middle and distal third humeral fractures feasible? A cadaveric study and clinical case series. J Orthop Traumatol 2023; 24:7. [PMID: 36764964 PMCID: PMC9918646 DOI: 10.1186/s10195-023-00684-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Iatrogenic injury to the radial nerve is a risk in surgical treatment for extraarticular fractures of the middle and distal third of the humerus. We aimed to investigate the safety, feasibility and advantages of minimally invasive percutaneous plate osteosynthesis (MIPPO) via an anteromedial approach in the treatment of middle and middle-distal humeral fractures and to evaluate proximity to neurovascular structures. MATERIALS AND METHODS In 2016, 13 adult cadaver arms were used to simulate a minimally invasive surgical approach to the anteromedial humerus followed by fixation with a locking compression plate (LCP), and several sets of anatomical data were measured to clarify the possible risk of iatrogenic vascular and nerve injury in this surgical approach. Then, a case series study of 12 patients with humeral fractures who were treated with this surgical approach was conducted between 2017 and 2020. RESULTS The average humeral length was 29.22 ± 1.62 cm, the average width of the medial epicondyle of the humerus was 1.31 ± 0.17 cm, and the average distance from the vertex of the medial epicondyle to the median nerve was 2.96 ± 1.62 cm. Furthermore, the safe area for distal humeral screw placement was 6.28 ± 0.39 cm, and the average distance from the tip of the distal end of the screw in the medial epicondyle to the ulnar nerve was 1.7 ± 1.25 mm. None of the 12 patients had nerve damage or an incisional infection after the operation. CONCLUSIONS The new approach was performed as described, and no cases of iatrogenic nerve palsy occurred. This approach can be used as an alternative for the treatment of extraarticular fractures of the middle and distal thirds of the humerus. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Jing Yang
- grid.452708.c0000 0004 1803 0208Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,grid.460689.5Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000 Xinjiang China
| | - Zhenxing Yang
- grid.460689.5Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000 Xinjiang China
| | - Dapeng Liu
- grid.460689.5Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000 Xinjiang China
| | - Zhanxin Lu
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China.
| | - Cheng Tao
- grid.452708.c0000 0004 1803 0208Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Videla-Cés M, Comas-Aguilar M, Endemaño-Lucio A, Sánchez-Navés R, Romero-Pijoan E, Videla S. Percutaneous helical plate fixation in humeral shaft fractures with proximal extension. Injury 2023; 54 Suppl 6:110750. [PMID: 38143117 DOI: 10.1016/j.injury.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Humeral shaft fractures with extension to the proximal third are increasingly frequent and technically more demanding. Surgical management of proximal metaphyseal junction humeral fractures is challenging. The aim of this study was to assess the safety, reproducibility, and possibility of early and completed rehabilitation in the percutaneous treatment with helical plates in humeral shaft fractures with proximal extension. PATIENTS AND METHODS This was a descriptive, retrospective, single-centre cohort study based on consecutive patients with proximal metaphyseal junction humeral fractures (MIPO-helical-plate-Broggi's cohort). Surgical technique (minimally invasive approach and osteosynthesis): percutaneous treatment with a twisted plate (helical plates). STUDY VARIABLES i): Intraoperative and postoperative (up to 1 year after surgery) safety; ii) Reproducibility of the surgical technique [number (percentage) of patients with surgical technique success]. The surgical technique success was defined as the recovering without neurovascular, implant failures and infection issues after one year follow up; and iii) Early and completed (3 months) rehabilitation [number (percentage) of patients]. A descriptive analysis was performed. RESULTS Between April 2010 to January 2022, we received 443 humeral shaft fractures at our unit. Of these, 350 fractures were treated surgically. 157 (44.9%) were treated using the minimally invasive approach and osteosynthesis technique with extramedullary implants, of which 46 (46/157, 29.3%, 9 men and 37 women) were performed with almost orthogonally twisted Philos® helical plates. The median (range) age was 67 (51-94) years. STUDY OUTCOMES i) Safety: None intraoperative events were gathered. No neurovascular, implant failure and infection issues were reported one year after surgery.; ii) Reproducibility of the surgical technique: only 1 failure (2%, 95%CI:0-11%), who was reoperated; and iii) Early and 3 month of rehabilitation was completed in 45 (98%, 95%CI:89-100%) patients. Forty-five (98%, 95%CI:89-100%) patients recovered their previous function the year after surgery. CONCLUSIONS The treatment of humeral shaft fractures with proximal extension based on a minimally invasive approach and osteosynthesis: percutaneous treatment with a twisted plate (helical plates), as this is a submuscular and extraperiosteal technique, is a safe and reproducible technique, and promotes early rehabilitation. In our opinion, it is surgical technique whose main requirement is a good knowledge of topographic anatomy.
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Affiliation(s)
- Miquel Videla-Cés
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain.
| | - Marta Comas-Aguilar
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain; Orthopaedic and Trauma Surgery Department. Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalonia, Spain
| | - Amaia Endemaño-Lucio
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Rubén Sánchez-Navés
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Eudald Romero-Pijoan
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Sebastián Videla
- Clinical Research Support Unit (HUB-IDIBELL), Clinical Pharmacology Department, Bellvitge University Hospital / Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Çukurlu M, Keçeli O, Ağır İ. Comparison of Posterior and Anterolateral Surgical Approaches in Treating Adult Humeral Shaft Fractures. Cureus 2023; 15:e39755. [PMID: 37398729 PMCID: PMC10311039 DOI: 10.7759/cureus.39755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
AIM The purpose of this study is to compare the outcomes and complications of two different surgical approaches, the anterolateral and posterior approaches, for treating humeral shaft fractures. MATERIALS AND METHODS Between January 2015 and May 2021, 51 patients with humeral shaft fractures were treated with anterolateral and posterior approaches. Twenty-nine patients were operated with the posterior approach (group 1) and 22 with the anterolateral approach (group 2). Statistical analyses were performed between the two groups regarding age, gender distribution, fractured side, body mass index (BMI), type of trauma, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification, and follow-up time. Complications such as operative time, amount of bleeding, incision length and implant fracture, radial nerve palsy, wound infection, and nonunion were compared between the two groups. Functional results of the elbow joint were evaluated with the Mayo Elbow Performance Score. RESULTS The mean follow-up period was 49.10±21.15 months (12-75 months) in group 1 and 50.00±23.71 months (range: 15-70 months) in group 2. There was no statistical difference between the groups in terms of age, gender distribution, fractured side, BMI, trauma type, AO/OTA classification, and follow-up time (p>0.05). There was no significant difference between the two groups in terms of operation time, intraoperative bleeding, and incision length (p>0.05). The mean Mayo Elbow Performance Score was 77.24±20.03 (range: 70-100 points) in group 1 and 81.36±8.34 (range: 70-100 points) in group 2, and no significant difference was found (p>0.05). When evaluated in terms of complications, there was no significant difference between the groups (p>0.05). While there was no significant difference between the two groups regarding elbow joint range of motion, the limitation was observed in more patients in group 1. CONCLUSION Similar satisfactory treatment results were obtained in patients who underwent anterolateral and posterior approaches in treating humeral shaft fractures. Furthermore, no difference was found between the two approaches regarding complication rates.
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Affiliation(s)
- Mustafa Çukurlu
- Department of Orthopaedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, TUR
| | - Ozan Keçeli
- Department of Orthopaedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, TUR
| | - İsmail Ağır
- Department of Orthopaedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, TUR
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Van Bergen SH, Mahabier KC, Van Lieshout EMM, Van der Torre T, Notenboom CAW, Jawahier PA, Verhofstad MHJ, Den Hartog D. Humeral shaft fracture: systematic review of non-operative and operative treatment. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04836-8. [PMID: 37093269 PMCID: PMC10374687 DOI: 10.1007/s00402-023-04836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/01/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Humeral shaft fractures can be treated non-operatively or operatively. The optimal management is subject to debate. The aim was to compare non-operative and operative treatment of a humeral shaft fracture in terms of fracture healing, complications, and functional outcome. METHODS Databases of Embase, Medline ALL, Web-of-Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for publications reporting clinical and functional outcomes of humeral shaft fractures after non-operative treatment with a functional brace or operative treatment by intramedullary nailing (IMN; antegrade or retrograde) or plate osteosynthesis (open plating or minimally invasive). A pooled analysis of the results was performed using MedCalc. RESULTS A total of 173 studies, describing 11,868 patients, were included. The fracture healing rate for the non-operative group was 89% (95% confidence interval (CI) 84-92%), 94% (95% CI 92-95%) for the IMN group and 96% (95% CI 95-97%) for the plating group. The rate of secondary radial nerve palsies was 1% in patients treated non-operatively, 3% in the IMN, and 6% in the plating group. Intraoperative complications and implant failures occurred more frequently in the IMN group than in the plating group. The DASH score was the lowest (7/100; 95% CI 1-13) in the minimally invasive plate osteosynthesis group. The Constant-Murley and UCLA shoulder score were the highest [93/100 (95% CI 92-95) and 33/35 (95% CI 32-33), respectively] in the plating group. CONCLUSION This study suggests that even though all treatment modalities result in satisfactory outcomes, operative treatment is associated with the most favorable results. Disregarding secondary radial nerve palsy, specifically plate osteosynthesis seems to result in the highest fracture healing rates, least complications, and best functional outcomes compared with the other treatment modalities.
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Affiliation(s)
- Saskia H Van Bergen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Kiran C Mahabier
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Tim Van der Torre
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelia A W Notenboom
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Priscilla A Jawahier
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Singh AP, Chauhan VD, Kumar S, Singh D. Minimally Invasive Plate Osteosynthesis (MIPO) Through the Posterior Approach for the Humerus: A Cadaveric Study. Cureus 2023; 15:e35578. [PMID: 37007387 PMCID: PMC10065362 DOI: 10.7759/cureus.35578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/04/2023] Open
Abstract
Background Minimally invasive plate osteosynthesis (MIPO) has been effectively used in femur and tibia fractures. MIPO in the humerus is conducted by anterior (most commonly used), lateral, and posterior approaches. However, in the anterior approach, in distal humeral diaphyseal fractures, there is a lack of adequate room for screw placement in the distal fragment for good stability. In such cases, the posterior approach for MIPO may be a propitious treatment method. However, the literature on MIPO using the posterior approach for humeral diaphyseal fractures is limited. This study aimed to evaluate the feasibility of MIPO through the posterior approach and study the association of radial nerve injury with MIPO through the posterior approach for the humerus. Methodology This experimental study was conducted in the Department of Orthopedics, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, and 20 cadaveric arms (10 right and 10 left) of 11 embalmed (formalin) cadavers were included (seven males and four females). Cadavers were placed prone on the dissection table. The posterolateral tip of the acromion and lateral epicondyle of the humerus were used as bony landmarks that were marked under C-Arm (Ziehm Imaging, Orlando, FL, USA) using K wires (Kirschner wires, Surgical Holdings, Essex, UK). Two incisions on the posterior part of the arm were made, and the radial nerve was identified at the proximal incision. After creating a submuscular tunnel, a 3.5 mm extraarticular distal humeral locking compression plate (LCP) was introduced over the posterior surface of the humerus and fixed to the humerus distally with one screw and then adjusted proximally and fixed to the humerus with another screw in the proximal window, followed by placement of couple more screws under C-Arm. After plate fixation, the dissection was completed to meticulously explore the radial nerve. The radial nerve was examined thoroughly for any injury sustained after completion of dissection, from the triangular interval to the lateral intermuscular septum where the nerve enters the anterior chamber. The position of the radial nerve with respect to plate holes was noted. The distance from the posterolateral tip of the acromion to the lateral epicondyle was measured as humeral length. The medial and lateral points where radial nerve passed over the posterior surface of the humerus were measured from the posterolateral tip of the acromion and compared with the humeral length. Results In this study, the radial nerve was lying over the posterior surface of the humerus for a mean distance of 52.161 ± 5.16 mm. The mean distance at which the radial nerve crossed the medial and lateral borders of the posterior surface of the humerus, measured from the posterolateral tip of the acromion, was 118.34 ± 10.86 mm (40.07% of humeral length) and 170 ± 12.30 mm (57.57% of humeral length), respectively, and the mean humeral length in this study was 295.27 ± 17.94 mm. The radial nerve and its branches were found to be intact in all cases. The radial nerve was related to the fifth, sixth, and seventh holes, with the nerve lying most commonly over the sixth hole (3.5 mm extraarticular distal humerus locking plate). Conclusions The posterior approach of MIPO in humeral fractures is a safe and reliable treatment modality with minimal risk of radial nerve injury. The radial nerve can be safely identified at the spiral groove using the bony landmarks described in our study.
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Wael M, Mahmoud Jaber MM, Abdullah MA, Atyani S, Jaber A, Halta NH, Ghannam M. Spiral Humeral Fracture During Arm Wrestling: A Case Report and Literature Review. Cureus 2022; 14:e29540. [PMID: 36312623 PMCID: PMC9592113 DOI: 10.7759/cureus.29540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 12/05/2022] Open
Abstract
Arm wrestling places an axial pressure load on the humerus with the glenohumeral joint stabilized and the elbow flexed and fixed. This situation can cause humeral shaft fractures. We present a case of humeral shaft fracture in a 22-year-old healthy man following an arm-wrestling challenge. The patient is known to be a bodybuilder and athlete. He presented to our university emergency department with a swollen and tender arm and intact neurovascular structures, reporting that he had recently engaged in arm wrestling with a colleague of similar shape and power. The fracture was treated conservatively based on the patient's informed decision using closed reduction and physiotherapy. He committed to scheduled clinic visits and physical therapy sessions and showed improvement with complete recovery and normal functioning on the thirteenth week.
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Fox HM, Hsue LJ, Thompson AR, Ramsey DC, Hadden RW, Mirarchi AJ, Nazir OF. Humeral shaft fractures: a cost-effectiveness analysis of operative versus nonoperative management. J Shoulder Elbow Surg 2022; 31:1969-1981. [PMID: 35398163 DOI: 10.1016/j.jse.2022.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/12/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral shaft fractures can be managed operatively or nonoperatively with functional bracing in the absence of neurovascular injury, open fracture, or polytrauma. A consensus on optimal management has not been reached, nor has the cost-effectiveness perspective been investigated. METHODS A decision tree was constructed describing the management of humeral shaft fractures with open reduction-internal fixation (ORIF), intramedullary nailing (IMN), and functional bracing in a non-elderly population. Probabilities were defined using weighted averages determined from systematic review of the literature. Cost-effectiveness was evaluated with incremental cost-effectiveness ratios, measured in cost per quality-adjusted life-year (QALY). Willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were evaluated. RESULTS Eighty-six studies were included. Using bracing as the referent in the health care model, we observed that bracing was the preferred strategy at both incremental cost-effectiveness ratio thresholds. ORIF and IMN had higher overall effectiveness (0.917 QALYs and 0.913 QALYs, respectively) compared with bracing (0.877 QALYs). The cost-effectiveness of bracing was driven by a substantially lower overall cost. In the societal model-accounting for both health care and societal costs-the cost difference narrowed between bracing, ORIF, and IMN. Bracing remained the preferred strategy at the $50,000/QALY threshold; ORIF was preferred at the $100,000/QALY threshold. ORIF and IMN were comparable strategies across a range of probability values in sensitivity analyses. CONCLUSIONS Functional bracing, with its low cost and satisfactory clinical outcomes, is often the most cost-effective strategy for humeral shaft fracture management. ORIF becomes preferable at the higher willingness-to-pay threshold when societal burden is considered. QALY values for ORIF and IMN were comparable.
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Affiliation(s)
- Henry M Fox
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Lauren J Hsue
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Austin R Thompson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Duncan C Ramsey
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Ryan W Hadden
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Adam J Mirarchi
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Omar F Nazir
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
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Obada B, Zekra M, Iliescu DM, Popescu IA, Costea DO, Petcu LC, Iliescu MG. Antegrade intramedullary locking nail in the management of proximal and middle thirds of humeral diaphyseal fractures. INTERNATIONAL ORTHOPAEDICS 2022; 46:1855-1862. [PMID: 35678843 DOI: 10.1007/s00264-022-05467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to evaluate the antegrade intramedullary locking nail osteosynthesis for the treatment of the proximal and middle thirds of humeral shaft fractures. METHODS A retrospective study was made on 218 patients diagnosed with humeral diaphysis fractures who undergo surgery with antegrade intramedullary locking nail between January 2017 and December 2021. The clinical follow-up started two days after surgery and continued at one month, three months, six months and one year. The functional recovery evaluation was performed using visual analogue scale (VAS) score, Rating Scale of American Shoulder and Elbow Surgeons Form (ASES), Mayo Elbow Performance Score System (MEPS) and rate of complications. RESULTS Low intra-operative blood loss, short operation time, short hospitalisation, early mobilisation of the patient and high union rate imposed intramedullary nailing as a standard procedure for the treatment of proximal and middle thirds of humeral diaphyseal fractures in the past years, and the union rate was 99.5%. VAS score evaluated at one month, three months and six months indicated a very good overall post-operative experience. The ASES and MEPS score were evaluated at six months and one year and showed excellent results. All the patients (except 1 case) were able to return to their previous jobs within six months. CONCLUSION Humeral nailing is associated with early return to function of the upper limb, with very good clinical and functional outcomes of the shoulder and elbow. This method could be considered the best surgical option for the management of proximal middle humeral fractures.
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Affiliation(s)
- Bogdan Obada
- Orthopaedic Traumatology Department, Emergency Clinical County Hospital, Constanta, Romania.
| | - Manar Zekra
- Orthopaedic Traumatology Department, Emergency Clinical County Hospital, Constanta, Romania
| | - Dan-Marcel Iliescu
- Department of Anatomy, Faculty of Medicine, "Ovidius" University of Constanta, Constanta, Romania
| | - Ion-Andrei Popescu
- Romanian Shoulder Institute, Ortopedicum - Orthopaedic Surgery & Sports Clinic, Bucharest, Romania
| | - Dan-Ovidiu Costea
- General Surgery Department, Emergency Clinical County Hospital, Constanta, Romania
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Jitprapaikulsarn S, Gromprasit A, Sukha K, Patamamongkonchai C, Jiamton C. Minimally invasive plate osteosynthesis via posterior approach for type B and C fractures of distal humeral shaft: surgical tactics and a clinical series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1431-1437. [PMID: 35377077 DOI: 10.1007/s00590-022-03255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
The optimal technique and implant for fixation of multifragmentary fractures of the distal humeral shaft remain inconclusive. We describe the use of minimally invasive plate osteosynthesis (MIPO) via posterior approach and extra-articular distal humerus locking compression plate (LCP-EADH) fixation for 18 such fractures. All fractures were united with a mean union time of 17.6 weeks (range 12-20). Transient radial nerve palsy was demonstrated in 2 patients. Six patients had 5° varus angulation and 1 had 5° valgus angulation. Triceps power was Grade 5 in all patients. The mean arc of elbow motion was 127.5 degrees (range 115-140). Six patients had an excellent MEP score and 12 had a good MEP score. As the results, posterior MIPO and LCP-EADH fixation could be an alternative for multifragmentary fractures of the distal humeral shaft, particularly for fractures with a very short distal fragment.
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Affiliation(s)
- Surasak Jitprapaikulsarn
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand.
| | - Arthit Gromprasit
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand
| | - Kritsada Sukha
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand
| | - Chawanan Patamamongkonchai
- Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand
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Yang J, Liu D, Zhang L, Lu Z, Liu T, Tao C. Treatment of humeral shaft fractures: a new minimally-invasive plate osteosynthesis versus open reduction and internal fixation: a case control study. BMC Surg 2021; 21:349. [PMID: 34551734 PMCID: PMC8459486 DOI: 10.1186/s12893-021-01347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the feasibility and safety of a new minimally-invasive surgical approach–anteromedial minimally-invasive plate osteosynthesis (MIPO)–in the treatment of middle and distal humeral shaft fractures. Methods Fourteen patients with humeral shaft fracture treated with anteromedial MIPO from November 2016 to March 2020 (MIPO Group) were selected as the study subjects. Open reduction and internal fixation (ORIF) were used to treat 14 patients with humeral shaft fractures as the control group (ORIF group). The two groups were fixed with a locking compression plate (LCP) or LCP + multi-directional locking screw system (MDLS). The incision length, intraoperative blood loss, intraoperative fluoroscopy time, operation time, length of hospital stay, fracture healing time, QuickDASH score and Constant score were observed and compared between the two groups. Results Fourteen patients were enrolled in each group. The incision length (7.79 ± 2.39 cm), intraoperative blood loss (96.07 ± 14.96 mL), operative time (110.57 ± 21.90 min), hospital stay (6.29 ± 1.49 days) and fracture healing time (14.94 ± 0.99 weeks) in the MIPO group were all lower than those in the ORIF group, and the difference was statistically significant for each parameter (P < 0.05). The intraoperative fluoroscopy time (20.07 ± 3.22) in the MIPO group was significantly higher than that in the ORIF group (P < 0.05). There were no significant differences in age (P = 0.078), QuickDASH score (P = 0.074) or Constant score (P = 0.293) between the two groups and no postoperative complications occurred in any of the patients. Conclusion The anteromedial approach MIPO technique has the advantages of less trauma, less bleeding, low risk of nerve injury and high rate of fracture healing. It is one of the most effective methods for the treatment of middle and middle–distal humeral shaft fractures.
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Affiliation(s)
- Jing Yang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.,Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Dapeng Liu
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Lina Zhang
- Department of Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Zhanxin Lu
- Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
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Anterior Minimally Invasive Plate Osteosynthesis for Humeral Shaft Fractures Is Safer Than Open Reduction Internal Fixation: A Matched Case-Controlled Comparison. J Orthop Trauma 2021; 35:424-429. [PMID: 33252449 DOI: 10.1097/bot.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Compare anterior minimally invasive plate osteosynthesis (MIPO) to open reduction/internal fixation (ORIF) for humeral shaft fractures, assessing complications and clinical outcomes. DESIGN Retrospective matched case-controlled cohort. SETTING Tertiary referral trauma centre. PATIENTS/PARTICIPANTS Humeral shaft fractures identified retrospectively over 5 years; 31 were treated by MIPO and 54 by ORIF. Matched-case cohort assembled according to fracture pattern, sex, age, and comorbidities, with 56 total patients (28 per group). INTERVENTIONS MIPO and ORIF. MAIN OUTCOME MEASURES Complication rate was the primary outcome (radial nerve injury, nonunion, infection, and reoperation). Radiographic alignment and the Disabilities of the Arm, Shoulder and Hand Score were secondary outcomes. RESULTS Cumulative complication rates were 3.6% after anterior MIPO and 35.7% after ORIF (P = 0.0004). The only complication after anterior MIPO was a nonunion, managed with revision ORIF and bone graft. The ORIF group had 10 complications, including 5 superficial infections, 4 iatrogenic radial nerve injuries, and 1 nonunion. The mean Disabilities of the Arm, Shoulder and Hand score after MIPO was 17.0 ± 18.0 and after ORIF was 24.9 ± 19.5. The mean coronal plane angulation after MIPO was 1.8 ± 1.3 degrees and after ORIF was 1.0 ± 1.2 degrees. The mean sagittal plane angulation after MIPO was 3.0 ± 2.9 degrees and after ORIF was 1.0 ± 1.2 degrees. CONCLUSIONS The cumulative complication rate was 10 times higher after ORIF of humeral shaft fractures compared with the MIPO technique. MIPO achieved nearly equivalent radiographic alignment, with no clinically meaningful differences observed. MIPO is the safer option and should be considered for patients with humeral shaft fractures that would benefit from surgical intervention. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Keshav K, Baghel A, Kumar V, Neradi D, Kaustubh K, Mishra P. Is Minimally Invasive Plating Osteosynthesis Better Than Conventional Open Plating for Humeral Shaft Fractures? A Systematic Review and Meta-Analysis of Comparative Studies. Indian J Orthop 2021; 55:283-303. [PMID: 34306542 PMCID: PMC8275817 DOI: 10.1007/s43465-021-00413-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of systematic review and meta-analysis was to find out whether minimally invasive plate osteosynthesis (MIPO) is better than open reduction and internal plate fixation (ORIF) in terms of functional outcome, achieving union (union time and incidence of non-union), intraoperative parameters (surgical duration, blood loss, and radiation exposure), and complications (iatrogenic radial nerve palsy and infection) for humeral shaft fractures. MATERIALS AND METHODS We searched online databases (Pubmed, Embase, Scopus, and The Cochrane Library) from inception till 3rd September 2020 for articles comparing MIPO with ORIF for humeral shaft fractures. The methodological quality of randomized controlled trials (RCTs) was done by Cochrane Risk of Bias assessment tool 2 (RoB2) and of non-randomized studies (case-control and cohort studies) by Methodological Index for non-randomized studies (MINORS). Meta-analysis was performed using Review Manager 5.4 software. RESULTS 11 studies (5 RCTs and 6 non-randomized comparative studies) involving a total of 582 patients (MIPO-290, ORIF-292) meeting our inclusion criteria were included in the study. There was no statistically significant difference in pooled analysis of functional outcome scores between MIPO and ORIF. Union time was significantly lesser (mean difference = 3.12 weeks) and incidence of non-union lower (odd's ratio = 0.27) in MIPO group. Surgical duration and intraoperative blood loss were significantly lesser in MIPO group. Iatrogenic radial nerve palsy and infection were higher in ORIF group. CONCLUSIONS This study showed that MIPO gives similar functional outcomes as compared to ORIF but causes significantly lesser blood loss, requires lesser operative duration and has a lesser incidence of major complications. TRIAL REGISTRATION International prospective register of systematic reviews (PROSPERO)-CRD42020208346, Date of registration 09/10/2020. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00413-6.
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Affiliation(s)
- Kumar Keshav
- Department of Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India
| | - Anurag Baghel
- Department of Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India
| | - Vishal Kumar
- Spine Surgery, Department of Orthopaedics, PGIMER, Chandigarh, 160012 India
| | - Deepak Neradi
- Spine Surgery, Department of Orthopaedics, PGIMER, Chandigarh, 160012 India
| | | | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India
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Beeres FJ, Diwersi N, Houwert MR, Link BC, Heng M, Knobe M, Groenwold RH, Frima H, Babst R, Jm van de Wall B. ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. Injury 2021; 52:653-663. [PMID: 33223254 DOI: 10.1016/j.injury.2020.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with open reduction internal fixation (ORIF) for humeral shaft fractures regarding non-union, re-intervention, radial nerve palsy, time to union, operation duration and functional outcomes. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing MIPO with ORIF for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies). RESULTS A total of two RCT's (98 patients) and seven observational studies (263 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. MIPO carries a lower risk for non-union (RD: 5%; OR 0.3, 95% CI 0.1-0.9) and secondary radial nerve palsy (RD 5%; OR 0.3, 95%CI 0.1- 0.9). Nerve function eventually restored spontaneously in all patients in both groups. Results were inconclusive regarding re-intervention (RD 7%; OR: 0.7, 95%CI 0.2-1.9), infection (RD 4%; OR 0.4, 95%CI 0.1-1.5), time to union (MD -1 week, 95%CI -3 - 1) and operation duration (MD -13 minutes, 95%CI -38.9 - 11.9). Functional shoulder scores (SMD 0.01, 95%CI -0.3 - 0.3) and elbow scores (SMD 0.01, 95%CI -0.3 - 0.3) were similar for the different operative techniques. CONCLUSION MIPO has a lower risk for non-union than ORIF for the treatment of humeral shaft fractures. Radial nerve palsy secondary to operation is a temporary issue resolving in all patients in both treatment groups. Although both treatment options are viable, the general balance leans towards MIPO having more favorable outcomes.
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Affiliation(s)
- Frank Jp Beeres
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Nadine Diwersi
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marijn R Houwert
- University Medical Center Utrecht, Department of Trauma Surgery, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marilyn Heng
- Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Department of Orthopedic Surgery, Boston, USA
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Rolf Hh Groenwold
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands
| | - Herman Frima
- Northwest Hospital group, Department of Trauma Surgery, Wendelaarstraat 58, 1814 GS Alkmaar, the Netherlands
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Bryan Jm van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
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Rellán I, Gallucci GL, Donndorff AG, De Carli P, Zaidenberg EE, Richard MJ, Boretto JG. Time until union in absolute vs. relative stability MIPO plating in simple humeral shaft fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:191-197. [PMID: 33778903 DOI: 10.1007/s00590-021-02920-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of this study is to evaluate the effect of absolute stability (AS) versus relative stability (RS) performed through a minimally invasive plate osteosynthesis (MIPO) in AO/OTA 12A1 and 12A2 fractures on healing and the time to radiographic union. METHODS This was a retrospective cohort study of all patients treated with plate fixation for AO/OTA type 12A1-A2 fractures at a single institution. Patients were grouped according to the type of stability used in their surgery. Time until radiographic union was estimated using the Kaplan-Meier method, which was compared by long-rank test between both types of surgical techniques. RESULTS A total of 70 patients were included in this study with 35 patients in each group. The median follow-up was 9 (IQR 6-14) months. The median time to radiographic union was significantly lower in the AS group than in the RS group: 12 (interquartile range (IQR) 10-14) weeks versus 18 (IQR 16-19) weeks, respectively (p < 0.001). Non-union was seen in two cases (7%) in the relative stability group. Three patients in the RS group developed a post-operative radial nerve palsy. CONCLUSION The main finding of this study is that the median time to radiographic union was significantly shorter in the patients treated with AS compared to those with a RS technique. These findings support the recommendations of the AO foundation in that simple metaphyseal fractures (type A) that require surgical treatment should be treated with an AS construct. RS techniques should be reserved to multifragmentary fractures where fragment preservation of blood supply is paramount.
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Affiliation(s)
- Ignacio Rellán
- Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Potosí 4215 (C1199ACK), Buenos Aires, Argentina.
| | - Gerardo Luis Gallucci
- Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Potosí 4215 (C1199ACK), Buenos Aires, Argentina
| | - Agustin Guillermo Donndorff
- Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Potosí 4215 (C1199ACK), Buenos Aires, Argentina
| | - Pablo De Carli
- Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Potosí 4215 (C1199ACK), Buenos Aires, Argentina
| | - Ezequiel Ernesto Zaidenberg
- Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Potosí 4215 (C1199ACK), Buenos Aires, Argentina
| | - Marc Joseph Richard
- Department of Orthopaedic Surgery, Division of Hand, Upper Extremity, and Microvascular Surgery, Duke University Medical Center, 4709 Creekstone Drive , Suite 200, Durham, NC, 27703, USA
| | - Jorge Guillermo Boretto
- Department of Orthopaedics, Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, Potosí 4215 (C1199ACK), Buenos Aires, Argentina
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Huang Q, Lu Y, Wang ZM, Sun L, Ma T, Wang Q, Li M, Liu HL, Hou MM, Xue HZ, Zhang K, Li Z. Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures. J Orthop Surg Res 2021; 16:197. [PMID: 33731159 PMCID: PMC7967943 DOI: 10.1186/s13018-021-02355-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background The surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures. This study compared clinical effects of the anterolateral approach with two incisions (AATI) and the posterior median approach (PMA) in the treatment of MDTHS fractures. Methods A retrospective analysis was carried out. One hundred sixty-six patients with MDTHS fractures were selected from January 2015 to January 2017 in Xi’an Hong Hui Hospital. According to surgical approaches, patients were divided into AATI (86 cases) and PMA group (80 cases). All patients were treated with open reduction and plate fixation. Operation indexes were compared, including incision length, operation time, and bleeding. Bryan-Morrey score was used to evaluate elbow joint function. Complication incidence was compared, such as incision infection, iatrogenic radial nerve injury, and nonunion. Results The AATI group showed smaller incision length, less bleeding, lower iatrogenic radial nerve injury rate, and better elbow function than that of PMA group (P<0.05). Conclusions The middle and distal-third humeral shaft fractures can be successfully cured by both approaches. Compared with the posterior median approach, it has better clinical effects of the anterolateral approach with two incisions, which is worthy of clinical application and promotion.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Yao Lu
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Zhi Meng Wang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Liang Sun
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Teng Ma
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Qian Wang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Ming Li
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Hong Liang Liu
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Ming Ming Hou
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Han Zhong Xue
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China.
| | - Zhong Li
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China.
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Capitani P, Chiodini F, Di Mento L, Cavanna M, Bove F, Capitani D, Berlusconi M. Locking compression plate fixation in humeral shaft fractures: A comparative study to literature conservative treatment. Injury 2021; 54 Suppl 1:S2-S8. [PMID: 33757663 DOI: 10.1016/j.injury.2021.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Humeral shaft fractures represent about 3% of all fractures. While there are several treatment options for this type of fractures, there is no evidence in literature showing which is the best one. This study aims at analysing the outcomes for patients with humeral shaft fractures treated with Locking Compression Plate (LCP) fixation in our hospital and comparing them with the outcome for patients conservatively treated (according to data from Pubmed),in order to determine the best treatment option. MATERIALS AND METHODS We treated surgically 220 humeral shaft fractures in our department from February 2005 to March 2012. Seventy-three of them met all the inclusion criteria for this study. All fractures were then classified according to the AO classification. The follow-up considered the radiographic healing of the fracture. All patients were treated with plate fixation (LCP - DePuySynthes Co). At the end of the four-year follow-up, the function was evaluated by means of the DASH score. A systematic review of the literature of the last 20 years was performed on MEDLINE (PubMed). RESULTS We had 2 infections and 8 patients had postoperative nerve palsy which recovered in average time of 6.7 months. In addition, 4 fractures (5.48%) didn't heal within 6 months and they were considered as nonunions and healed after a second surgery. One of these 4 nonunions was infected. The mean DASH score was 18.24±19.18. No malunions were found. We identified 13 studies that were eligible for our systematic review. The mean non-union rate found was 17% in 2517 fractures with a follow-up that ranging from 67% to 100% of patients and a primary radial nerve palsy ranging from 0 to 115 patients. Malalignment rate ranged from 12.7 to 42%. CONCLUSIONS After taking into account both the conservative and the surgical treatment, for humeral shaft fractures we suggest the operative treatment, because the patient's function of the upper limb recovers quickly in the immediate postoperative period and the incidence of malunions may be avoided.
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Affiliation(s)
- P Capitani
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy; Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - F Chiodini
- Department of Orthopedics and Traumatology, ASST Ovest Milanese - Ospedale di Legnano, Legnano, Italy
| | - L Di Mento
- Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Cavanna
- Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - F Bove
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - D Capitani
- Department of Orthopedic Surgery and Traumatology, ASST GOM Niguarda, Milan, Italy
| | - M Berlusconi
- Trauma Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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18
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Jovanović S, Miljković N, Petrović D, Jakšić L, Radojević G, Božović A. Treatment fracture of the diaphisis humerus with functional plaster. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2104035j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Treatment of humerus fractures is divided into operative and non-operative treatment Fractures of the diaphysis of the humerus heal well. Surgeons today have many opportunities to treat them. The decision on the type of treatment to be applied depends on the location of the fracture, the existence of associated injuries, the age and the general condition of the patient. Non-operative treatment is most often applied, although there are fractures in which surgical intervention is necessary in order to perform healing and prevent complications. Non-operative treatment of fractures of the diaphysis of the humerus gives good results, with little angulation and minimal or no shortening of the arm. Adequate repositioning, appropriate plaster immobilization and regular X-rays heal the fracture within the allotted time. Disciplined early physical therapy in terms of circular movements prevents shoulder contracture and allows later physical therapy to last significantly shorter. Non-operative treatment lasts from 7-11,5 weeks.
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Hendrickx LAM, Hilgersom NFJ, Alkaduhimi H, Doornberg JN, van den Bekerom MPJ. Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients. Arch Orthop Trauma Surg 2021; 141:561-568. [PMID: 32285189 PMCID: PMC7966639 DOI: 10.1007/s00402-020-03446-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Humeral shaft fractures are often associated with radial nerve palsy (RNP) (8-16%). The primary aim of this systematic review was to assess the incidence of primary and secondary RNP in closed humeral shaft fractures. The secondary aim was to compare the recovery rate of primary RNP and the incidence of secondary RNP between operative and non-operative treatment. METHODS A systematic literature search was performed in 'Trip Database', 'Embase' and 'PubMed' to identify original studies reporting on RNP in closed humeral shaft fractures. The Coleman Methodology Score was used to grade the quality of the studies. The incidence and recovery of RNP, fracture characteristics and treatment characteristics were extracted. Chi-square and Fisher exact tests were used to compare operative versus non-operative treatment. RESULTS Forty studies reporting on 1758 patients with closed humeral shaft fractures were included. The incidence of primary RNP was 10%. There was no difference in the recovery rate of primary RNP when comparing operative treatment with radial nerve exploration (98%) versus non-operative treatment (91%) (p = 0.29). The incidence of secondary RNP after operative and non-operative treatment was 4% and 0.4%, respectively (p < 0.01). INTERPRETATION One-in-ten patients with a closed humeral shaft fracture has an associated primary RNP, of which > 90% recovers without the need of (re-)intervention. No beneficial effect of early exploration on the recovery of primary RNP could be demonstrated when comparing patients managed non-operatively with those explored early. Patients managed operatively for closed humeral shaft fractures have a higher risk of developing secondary RNP. LEVEL OF EVIDENCE Level IV; Systematic Review.
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Affiliation(s)
- Laurent A. M. Hendrickx
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, 5042 Australia
| | - Nick F. J. Hilgersom
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, 1091 Amsterdam, The Netherlands
| | - Hassanin Alkaduhimi
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, 1091 Amsterdam, The Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, 5042 Australia
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Chamseddine AH, El-Hajj OM, Haidar IM, Rahal MJH, Farhat HS, Hellani AA, Asfour AH, Zeyneddin MM. Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures. INTERNATIONAL ORTHOPAEDICS 2020; 45:253-263. [PMID: 33094402 DOI: 10.1007/s00264-020-04858-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE The objective of this study was to evaluate the feasibility and safety of a minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure for proximal humeral shaft fractures using lateral minimal proximal and distal approaches and lateral bridge plating with primary radial nerve control, and to assess its clinical and radiographic outcomes. METHODS A retrospective review was done for the medical records of adult patients admitted for fracture of the proximal humeral shaft without associated injury to the ipsilateral upper limb and who consented to undergo a novel MIPPO technique herein reported. Patients were reviewed at regular follow-up periods and assessed at a final follow-up for evaluation of Constant, normalized Constant, and QuickDASH scores. RESULTS There were 21 adult patients with mean age of 56 years. Three patients were lost from early follow-up; one of them had post-operative radial nerve paralysis. Eighteen patients were reviewed for the purpose of this study at a mean of 20 months of final follow-up; among them, one patient developed post-operative radial nerve paralysis with complete recovery after three months. Bone healing was achieved without any malalignment in 17 patients at a mean of 15 weeks, and one patient developed nonunion. At final assessment (mean, 20 months), the mean values of Constant, normalized Constant, and QuickDASH scores were 84 (range, 59 to 100), 95 (range, 73 to 100), and 5 (range, 0 to 18.2) respectively. CONCLUSION Compared to pre-reported methods of MIPPO, this technique of lateral proximal and distal mini-approaches with lateral bridge plating after primary control of the radial nerve seems safe and feasible for proximal humeral shaft fractures. It gives good clinical and radiographic results with excellent restoration of upper limb function, very low incidence of post-operative radial nerve injury, and high rate of bone union in good alignment.
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Affiliation(s)
- Ali Hassan Chamseddine
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon.
| | - Oussama M El-Hajj
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Ibrahim M Haidar
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Mohammad Jawad H Rahal
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Hussein S Farhat
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Ali A Hellani
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Ali H Asfour
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
| | - Mariam M Zeyneddin
- Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Lebanon
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Giordano M, Giordano V, Gameiro VS, Belangero W, Livani B, Giannoudis PV, Krettek C. Anterior minimally invasive plating osteosynthesis technique (MIPO) for humeral shaft fractures: an anatomical study of neuromuscular structures at risk. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:449-458. [PMID: 32929614 DOI: 10.1007/s00590-020-02792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the neuromuscular structures at risk during modified anterior minimally invasive plating osteosynthesis technique (Belangero-Livani) for humeral shaft fractures. METHODS Eight fresh-frozen human specimens ranging from 38 to 82 years old were used. Specimens were positioned supine with the shoulder in 70° abduction and the forearm in full supination. Anterior minimally invasive plating osteosynthesis technique according to Belangero-Livani technique was performed in each specimen. Under radioscopic control, the plate was introduced in retrograde fashion through the subbrachialis path. Anatomical structures were inspected and different anatomical parameters were measured after dissection at the end of the surgical procedures. Measurements were performed using a high digital caliper. Statistical analysis was performed using the Pearson's correlation coefficient test. A p value of < 0.05 was used to define statistical significance. RESULTS There were no macroscopic lesions of myotendinous or neurovascular structures in any specimen. The mean distance between the radial nerve to the distal lateral end of the plate was 8.63 mm (range 4.14-13.83 mm). The mean total length of the humerus was 328.59 mm. We found a significant direct correlation between the total length of the humerus and both specimen height and weight. CONCLUSION The modified Belangero-Livani anterior MIPO technique for humeral shaft fractures performed in retrograde fashion is safe and useful, without major risk to the soft tissue of the anterior compartment of the arm, including the radial nerve in the lateral intermuscular septum. Intraoperative dissection, avoiding deep lateral retraction on the distal approach, minimizes the risk of radial nerve damage. Strict surgical planning and appreciation for the anatomic landmarks can reduce the risk of damage to neuromuscular structures. LEVEL OF EVIDENCE Level IV; Case series with no comparison group; Treatment study.
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Affiliation(s)
- Marcos Giordano
- Serviço de Traumato-Ortopedia, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'Or São Luiz, Rio de Janeiro, Brazil.
| | | | - William Belangero
- Departamento de Ortopedia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP), Campinas, Brazil
| | - Bruno Livani
- Departamento de Ortopedia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP), Campinas, Brazil
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
| | - Christian Krettek
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH), Hannover, Germany
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Li Y, Tian Q, Leng K, Guo M. Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study. Med Sci Monit 2020; 26:e924400. [PMID: 32639953 PMCID: PMC7366785 DOI: 10.12659/msm.924400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to retrospectively assess and compare the functional outcomes and complications following anterolateral versus posterior surgical approaches for the treatment of mid-shaft fractures of the humerus. Material/Methods This study included 107 patients treated for mid-shaft fractures between May 2015 and July 2018. Demographic and surgical data were collected for each patient. During follow-up visits, radiographs were acquired and evaluated. The clinical outcomes of the involved joints were assessed by the Constant scoring system, range of motion (ROM), and the Mayo Elbow Performance Scoring system at the 12-month follow-up. Results The posterior approach was performed in 57 patients with type A fractures (group I, n=28) and type B or C fractures (group III, n=29). The anterolateral approach was performed in 50 patients with type A fractures (group II, n=32) and type B or C fractures (group IV, n=18). There were no significant differences between group I and group II nor between group III and group IV with respect to patient demographic data, surgical data, Constant score, ROM, or Mayo Elbow Performance score. A significant difference in the total complication rate was observed between group I and II. Conclusions The anterolateral approach showed an advantage over the posterior approach for treating simple humeral mid-shaft fractures. However, this advantage was not observed in treating comminuted fractures.
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Affiliation(s)
- Yihan Li
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Qingxian Tian
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Kungpeng Leng
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Meng Guo
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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Anterior minimally invasive plating osteosynthesis using reversed proximal humeral internal locking system plate for distal humeral shaft fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1515-1521. [PMID: 32468266 DOI: 10.1007/s00590-020-02708-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/22/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the surgical application of anterior minimally invasive plating osteosynthesis (MIPO) using reversed proximal humerus internal locking system (PHILOS) plate for multifragmentary distal humeral shaft fractures. METHODS Twelve patients with distal humeral shaft fractures (type 12B, n = 6 and type 12C, n = 6) were operated on by anterior MIPO and reversed PHILOS plate fixation. The amount of intact bone in the distal fragment was measured by fracture-to-coronoid distance (FCD). Data of the postoperative alignment, complications, union time, and clinical outcomes were collected. RESULTS The mean time for fractures to unite in all patients was 14.8 weeks (range 12-22). There was no perioperative complication. The mean FCD was 4.8 cm (range 2.1-8.1). The mean coronal angulation was 3.4° (range 0-9), and the mean sagittal angulation was 1° (range 0-5). All patients had excellent UCLA shoulder score and MEP score results, and the mean range of elbow motion was 140° (range 130-145). CONCLUSION Anterior MIPO using reversed PHILOS plate is safe and effective for multifragmentary fractures of the distal humeral shaft even in a fracture with a length of intact bone above the coronoid fossa of only 2 cm.
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Sadek AF, Ahmed MA, Kader MA, El-Shafie MBE. Lateral condylar retrograde humeral nail for management of high-energy distal humeral fractures. J Orthop Surg (Hong Kong) 2020; 27:2309499019847922. [PMID: 31104585 DOI: 10.1177/2309499019847922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Distal metaphyseo-diaphyseal humeral fractures are challenging particularly if open, comminuted, or associated with nerve injury. In cases of open distal complex metaphyseo-diaphyseal humeral fractures inamenable for traditional methods of fixation, retrograde intramedullary locked humeral nail with a new lateral condylar point of entry has been proposed. METHODS Two phases of study were conducted; phase I comprised computerized tomography evaluation of right humeri of 120 adult subjects, while phase II entailed prospective analysis of 18 patients who sustained firearm injuries resulting in open distal metaphyseo-diaphyseal humeral fractures associated with radial nerve injuries. All patients were surgically managed using lateral condylar retrograde humeral nailing with primary radial nerve exploration. RESULTS Distal sagittal medullary diameter of the humeral medulla was the narrowest in comparison to axial and coronal medullary diameters in phase II, which matched the results of phase I. The mean postoperative disability of the arm, shoulder, and hand score was 11.2 ± 6.4. Only five patients underwent subsequent successful tendon transfer. CONCLUSIONS Lateral condylar retrograde humeral nail with early radial nerve exploration in cases of high-energy distal metaphyseo-diaphyseal humeral fractures yielded good results regarding union and spontaneous radial nerve recovery or later on reconstruction.
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Affiliation(s)
- Ahmed Fathy Sadek
- 1 Department of Orthopaedic Surgery, Minia University Hospital, Minia, Egypt
| | - Mohamed Atef Ahmed
- 1 Department of Orthopaedic Surgery, Minia University Hospital, Minia, Egypt
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Jeong JJ, Park SE, Lee HH, Ji JH, Park MS, Park YT. Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures. BMC Musculoskelet Disord 2019; 20:381. [PMID: 31421675 PMCID: PMC6698331 DOI: 10.1186/s12891-019-2757-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension. Methods From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up. Results All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures. Conclusions In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.
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Affiliation(s)
- Jae-Jung Jeong
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Sang-Eun Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Hwan-Hee Lee
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Jong-Hun Ji
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea.
| | - Min-Sik Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Yong-Taek Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
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Xie ZX, Zhou XT, Zhang DS, Yang Y, Zhang GL, Chen MH, Liang Z. Minimally invasive plate osteosynthesis for the treatment of sternal fracture in the lower chest: a case report. J Int Med Res 2019; 47:4033-4038. [PMID: 31364423 PMCID: PMC6726812 DOI: 10.1177/0300060519865074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sternal fracture is a common complication of chest trauma but has a low incidence. Various treatments have been developed to reconstruct sternal fractures. Among these approaches, analgesia, corset fixation, and open reduction with plate internal fixation have been suggested. The use of newly developed minimally invasive plate osteosynthesis is a feasible method. In this study, we report a case involving a 54-year-old man with a sternal fracture accompanied by bilateral pleural effusion and a small amount of right-sided pneumothorax. The patient was treated with minimally invasive plate osteosynthesis. The operation was successful and the postoperative recovery was good. No pneumothorax or complications such as chest pain, paresthesia, or wound infection were observed at the 1-year follow-up visit. Additionally, the bilateral pleural effusion had been completely absorbed. The incision in the lower chest was aesthetic and minimally traumatic. This case describes a novel method for internal fixation of sternal fractures.
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Affiliation(s)
- Ze-Xin Xie
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Xue-Tao Zhou
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Dong-Sheng Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Yang Yang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Guo-Liang Zhang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Meng-Hui Chen
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Zheng Liang
- Department of Cardiothoracic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
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Kadar A, Kahan JB, Leslie MP, Yoo BJ, Baumgaertner MR. Safe Zones for Cerclage Wiring of the Humeral Diaphysis. Clin Anat 2019; 33:552-557. [PMID: 31301242 DOI: 10.1002/ca.23433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 11/07/2022]
Abstract
Cerclage wiring of the humeral diaphysis entails particular danger to the radial nerve and the deep brachial artery. We sought to delineate safe zones for minimally invasive cerclage wiring of the humeral diaphysis, specifically in relation to the radial nerve and accompanying vasculature. Cerclage wires were percutaneously inserted into three groups of fresh-frozen cadaveric humeri. Group 1-proximal midshaft humerus at 30% of humeral height (n = 4); Group 2-midshaft spiral groove at 45% of humeral height (n = 4); and Group 3-distal midshaft humerus at 60% of humeral height (n = 4). Subsequently, an extensive surgical exploration of the arteries and nerves around the humerus was performed, noting any disturbance to the vessels or nerves and measuring the distance from the cerclage wire to the radial nerve. Neurovascular structures were injured in 75% of specimens when the cerclage wire was inserted at the level of the spiral groove. Both posterior structures, e.g. the radial nerve and the deep brachial artery, and medial structures, e.g., the median nerve and brachial artery, were incarcerated. Application of the cerclage at 30% or 60% of humeral height did not cause neurovascular injury. Minimally invasive application of the cerclage wire at the spiral groove, which is at 45% of humeral height, is likely to cause injury to neurovascular structures. Application of the cerclage at the proximal or distal midshaft humeral areas is associated with less risk of such injury. Clin. Anat. 33:552-557, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Assaf Kadar
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph B Kahan
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Michael P Leslie
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Brad J Yoo
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
| | - Michael R Baumgaertner
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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Buranaphatthana T, Apivatthakakul T, Apivatthakakul V. Anteromedial minimally invasive plate osteosynthesis (MIPO) for distal third humeral shaft fractures - Is it possible?: A cadaveric study. Injury 2019; 50:1166-1174. [PMID: 31072594 DOI: 10.1016/j.injury.2019.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/08/2019] [Accepted: 04/28/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the feasibility of the anteromedial minimally invasive plate osteosynthesis (MIPO) approach for distal third humeral shaft fractures and identify neurovascular structures at risk with this approach. METHODS Twenty cadaveric arms were fixed with 12-hole precontoured narrow locking compression plates (LCP) with the anteromedial approach using MIPO technique. The proximal approach was done between the biceps and deltoid muscle directly to the bone. The distal approach involved elevating the brachialis from medial intermuscular septum. The plate was inserted beneath the brachialis tunnel from distal to proximal. Three locking screws were fixed at each end through incisions and the rest of screws were inserted percutaneously. The arms were then dissected to identify damage to or direct contact between the screws and brachial artery (BA), median nerve (MN), musculocutaneous nerve (MCN), and radial nerve (RN). The distances from the screws to structures at risk, humeral length, and length of three distal screws in mediolateral (ML) direction were measured. RESULTS The average humeral length was 28.97 cm. The average danger zone for the BA and MN were 20.47%-62.66% of the humeral length from the lateral epicondyle, and 20.47%-75.02% for the MCN. The ulnar nerve was not endangered by this approach as it lies posteromedially to the humerus. The danger zone for the RN averaged 27.07%-43.74%, and the most dangerous screw that either penetrated or touched the nerve was at the fifth hole, which lay at 33.14% of the humeral length. The average length of three distal screws in ML direction were 41.4, 25.0 and 22.5 mm. CONCLUSIONS The anteromedial MIPO approach can be performed through the internervous plane beneath the brachialis muscle without exposing any nerves or causing any muscle splitting with a 12-hole plate. Both proximal and distal screw insertion must be done with direct exposure. Insertion of percutaneous screws in the middle part of the plate between the two incisions is not possible. This approach could be an alternative for extra-articular distal third humeral shaft fractures which provides less invasive surgical dissection, allows the use of longer distal screws, and achieves better cosmesis.
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Affiliation(s)
- T Buranaphatthana
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - T Apivatthakakul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Musculoskeletal Science and Translational Research Center (MSTR), Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - V Apivatthakakul
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Minimally Invasive Plate Osteosynthesis of Humeral Shaft Fractures: Current State of the Art. J Am Acad Orthop Surg 2018; 26:652-661. [PMID: 30113346 DOI: 10.5435/jaaos-d-17-00238] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Most closed humeral shaft fractures can be successfully managed nonsurgically. However, fractures for which closed treatment is unsuccessful are stabilized using either plates or intramedullary nails. There are shortcomings associated with each technique, including the potential complications of nonunion, infection, shoulder pain, and radial nerve injury. Minimally invasive plate osteosynthesis (MIPO), an innovative alternative treatment, is gaining in popularity. This technique is based on the anterior humeral shaft providing a relatively safe surface for plate application, and limited open exposures proximally and distally allow percutaneous insertion of the necessary implant. More than 40 articles have been published regarding MIPO, and it compares favorably to other available forms of treatment with excellent functional outcomes and a lower rate of iatrogenic radial nerve injury. Larger randomized controlled trials comparing this method with other accepted techniques, including nonsurgical management, are necessary to better define the role of MIPO in the management of humeral shaft fractures.
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Chang H, Yao ZL, Hou YL, Cao Y, Guo XH, Li GJ, Yu B. Lateral Subcutaneous Locking Compression Plate and Small Incision Reduction for Distal-third Diaphyseal Humerus Fractures. Orthop Surg 2018; 10:218-226. [PMID: 30152611 PMCID: PMC6175191 DOI: 10.1111/os.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/04/2017] [Indexed: 12/04/2022] Open
Abstract
Objective Iatrogenic radial nerve injury is a great challenge for orthopaedic surgeons who deal with distal‐third diaphyseal humerus fractures. Conventional open reduction and internal fixation (ORIF) remains the gold standard, but complications such as nonunion and iatrogenic radial nerve injury still occur. We fixed the fractures with a lateral locking compression plate (LCP) subcutaneously after small incision reduction to protect the radial nerve. This study reports the clinical and radiographic outcomes of our modified method. Methods Thirty‐eight patients with distal‐third diaphyseal humerus fractures were treated with lateral subcutaneous LCP and small incision reduction at our department between September 2013 and August 2016. There were 33 males and 5 females, with an average age of 30.3 years (range, 17 to 49 years). All the cases were types A or B (AO/OTA classification, type A, 24 cases; type B, 14 cases). Among them, 6 cases were combined with preoperative radial nerve palsy. All patients were diagnosed with closed humeral fractures after X‐ray examination, and had typical upper limb pain, swelling, and movement disorders. The operations were performed by a single surgeons’ team. Union time, range of motion (ROM), University of California, Los Angeles (UCLA) shoulder rating scale, and Mayo Elbow Performance Index (MEPI) scores were assessed to evaluate the postoperative results. Results All patients were followed up for an average of 11.4 months (range, 3 to 36 months). The average operation time was 75.5 min (range, 60 to 150 min) and average intraoperative radiation exposure was 10.5 s (range, 8 to 18 s). Bony union was achieved in all cases after an average of 16.2 weeks (range, 12 to 25 weeks). No complications such as infection or screw and plate fracture occurred, and no iatrogenic radial nerve injury was observed. According to the UCLA shoulder rating scale, the average score was 33.7 (range, 31 to 35), with 33 excellent (86.8%) and 5 good cases (13.2%). They were all excellent according to their MEPI scores (ranging, 94 to 100, with an average of 97.4). The average operation time for secondary removal of the plate was 15.2 min (range, 10 to 20 min), and no complications such as infection or secondary radial nerve injury occurred. Conclusions Lateral subcutaneous LCP and small incision reduction may reduce the risk of iatrogenic radial nerve injury significantly in the treatment of distal‐third diaphyseal humerus fractures. It also leads to solid fixation, good postoperative function, and convenient removal of the plate without injuring the radial nerve.
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Affiliation(s)
- Hong Chang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, 421 Hospital of PLA, Guangzhou, China
| | - Zi-Long Yao
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Long Hou
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Cao
- Department of Orthopaedics, 421 Hospital of PLA, Guangzhou, China
| | - Xin-Hui Guo
- Department of Orthopaedics, 421 Hospital of PLA, Guangzhou, China
| | - Guan-Jun Li
- Department of Orthopaedics, 421 Hospital of PLA, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Saengsin J, Vaseenon T, Pattamapaspong N, Kritsaneephaiboon A. Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study. Injury 2017; 48:1758-1763. [PMID: 28689808 DOI: 10.1016/j.injury.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/13/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. METHODS Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. RESULT All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P<0.05). CONCLUSION Images from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted.
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Affiliation(s)
- Jirawat Saengsin
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanawat Vaseenon
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apipop Kritsaneephaiboon
- Department of Orthopaedics, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Kulkarni VS, Kulkarni MS, Kulkarni GS, Goyal V, Kulkarni MG. Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures. Injury 2017; 48 Suppl 2:S8-S13. [PMID: 28802426 DOI: 10.1016/s0020-1383(17)30487-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The three currently used methods of treatment: namely open reduction plate osteosynthesis (ORPO), Minimally invasive plate osteosynthesis (MIPO), antegrade intramedullary nailing(IMN) are all reported as satisfactory procedures for treatment of humeral shaft fractures. However none of the published reports have a comparison of superiority of one procedure over the other. We evaluated the clinical, radiological and functional outcome of the three procedures. MATERIALS AND METHODS We studied adult patients with humerus shaft fractures over a period of 2 years from May 2014 to May 2016 in a level 1 trauma center. Forty-four were treated with IMN, 34 treated with ORPO, and 34 with MIPO. The null hypothesis tested in this study is that there is no difference between IMN, ORPO, MIPO with respect to union time, surgical time, complication rate, non-union rate and functional outcome. Functional outcome was studied by comparing the UCLA shoulder and MEP scores in the three groups. RESULTS 112 patients were studied consisting of 83 males and 29 females with mean age of 39 years (range 18-70). IMN group showed early union with mean of 12.73 weeks compared to MIPO (14.45 weeks) and ORPO(13.58 weeks), (p<0.05). MIPO had no events of non-union, as compared to ORPO (5 non-unions) and IMN (10 non-unions), (p=0.04). The range of movement at the shoulder with the UCLA score was significantly better with a score of 32.26 in MIPO as compared to 27.54 in IMN and 28.82 in ORPO (p<0.05). The difference in MEPS score in the three groups was not significant (p=0.31). IMN required a mean of 117.95 minutes intraoperatively as compared to 131 and 150.58 mins in MIPO, ORPO respectively. CONCLUSION MIPO is overall better with respect to non-union, functional outcome and complications rate. The surgical time depends on the surgeons' skill and learning curve. Thus considering the advantages and risks involved in the various procedure and surgical acumen, each case should be individualized to have a good outcome. We advocate that MIPO can be safely used as an alternative in treating these fractures.
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Affiliation(s)
- Vidisha Sunil Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| | - Madhura Sujay Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India.
| | - Govind Shivram Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| | - Vaibhav Goyal
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| | - Milind Govind Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
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Rämö L, Taimela S, Lepola V, Malmivaara A, Lähdeoja T, Paavola M. Open reduction and internal fixation of humeral shaft fractures versus conservative treatment with a functional brace: a study protocol of a randomised controlled trial embedded in a cohort. BMJ Open 2017; 7:e014076. [PMID: 28694341 PMCID: PMC5734401 DOI: 10.1136/bmjopen-2016-014076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Humeral shaft fractures represent 1%-3% of all fractures and 20% of humeral fractures in adults. The treatment of these fractures is mainly conservative and operative treatment is usually reserved for specific circumstances. To date, no randomised controlled trial (RCT) has compared operative treatment of humeral shaft fractures with conservative treatment. METHODS AND ANALYSIS We will conduct an RCT to compare the effectiveness and cost-effectiveness of surgical and conservative treatment of humeral shaft fractures. After providing informed consent, 80 patients from 18 years of age with humeral shaft fracture will be randomly assigned to open reduction and internal fixation with locking plate or conservative treatment with functional bracing. We will follow the patients for 10 years and compare the results at different time points. The primary outcome will be Disabilities of Arm, Shoulder and Hand (DASH) at 12 months. The secondary outcomes will include Numerical Rating Scale for pain at rest and in activities, Constant Score and quality of life instrument 15D. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort follow-up study, 'the declined cohort'. This cohort will be followed up at the same time points as the randomised patients to assess the potential effect of participation bias on RCT results and to enhance the external validity of the RCT. In one of the recruiting centres, all cooperative patients with humeral shaft fractures not eligible for randomisation will be asked to participate in a 'non-eligible cohort' study. We will use blinded data interpretation of the randomised cohort to avoid biased interpretation of outcomes. Our null hypothesis is that there is no clinically relevant difference in the primary outcome measure between the two treatment groups. We will consider a difference of a minimum of 10 points in DASH clinically relevant. ETHICS AND DISSEMINATION The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings of this study through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT01719887; pre-results.
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Affiliation(s)
- Lasse Rämö
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Simo Taimela
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Vesa Lepola
- Department of Orthopaedics and Traumatology, Tampere University Central Hospital, Tampere, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuomas Lähdeoja
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
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Zhao W, Qu W, Fu C, Jiang H, Liu S, Cheng C. Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus. INTERNATIONAL ORTHOPAEDICS 2017; 41:1757-1762. [PMID: 28577034 DOI: 10.1007/s00264-017-3514-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/11/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Traditional open reduction and internal fixation (ORIF) of extra-articular distal humerus fractures has a risk of iatrogenic radial nerve injury, extensive soft tissue stripping, and long incision scar. We performed an antero-lateral minimally invasive plate osteosynthesis (MIPO) technique with the radial nerve exploration for distal-third diaphyseal fractures of the humerus and evaluated clinical and radiographic outcomes through this respective study. METHODS From April 2010 to June 2016, 28 cases of extra-articular distal-third diaphyseal fractures were treated with an antero-lateral MIPO procedure. Patient demographics, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Mayo Elbow Performance (MEP) Score, elbow range of motion, scars and post-operative complications were recorded and analyzed. RESULTS All fractures were united with a mean time of 3.5 months. One patient exhibited delayed union (3.6%). The mean DASH Score was 6.6, and all patients had excellent or good MEP Score values. The average scar length was 6.8 cm, and the shortest was 4.5 cm. CONCLUSIONS The MIPO technique via an antero-lateral approach for extra-articular distal-third diaphyseal fractures of the humerus results in satisfactory clinical outcomes. LEVEL OF EVIDENCE Level IV, case series, treatment study.
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Affiliation(s)
- Wei Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Wei Qu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China.
| | - Chongyang Fu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Huajun Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Sida Liu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
| | - Chao Cheng
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Street, Dalian, Liaoning, 116011, China
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Matsunaga FT, Tamaoki MJS, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures: A Randomized Controlled Trial. J Bone Joint Surg Am 2017; 99:583-592. [PMID: 28375891 DOI: 10.2106/jbjs.16.00628] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nonoperative treatment has historically been considered the standard for fractures of the shaft of the humerus. Minimally invasive bridge-plate osteosynthesis for isolated humeral shaft fractures has been proven to be a safe technique, with good and reproducible results. This study was designed to compare clinical and radiographic outcomes between patients who had been treated with bridge plate osteosynthesis and those who had been managed nonoperatively with a functional brace. METHODS A prospective randomized trial was designed and included 110 patients allocated to 1 of 2 groups: surgery with a bridge plate or nonoperative treatment with a functional brace. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 months. The score on the Short Form-36 (SF-36) life-quality questionnaire, complications of treatment, Constant-Murley score for the shoulder, pain level, and radiographic results were assessed as secondary outcomes. Participants were assessed at 2 weeks; 1, 2, and 6 months; and 1 year after the interventions. RESULTS The mean DASH score of the bridge plate group was statistically superior to that of the functional brace group (mean scores, 10.9 and 16.9, respectively; p = 0.046) only at 6 months. The bridge plate group also had a significantly more favorable nonunion rate (0% versus 15%) and less mean residual angular displacement seen on the anteroposterior radiograph (2.0° versus 10.5°) (both p < 0.05). No difference between the groups was detected with regard to the SF-36 score, pain level, Constant-Murley score, or angular displacement seen on the lateral radiograph. CONCLUSIONS This trial demonstrates that, compared with functional bracing, surgical treatment with a bridge plate has a statistically significant advantage, of uncertain clinical benefit, with respect to self-reported outcome (DASH score) at 6 months, nonunion rate, and residual deformity in the coronal plane as seen on radiographs. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Fabio Teruo Matsunaga
- 1Division of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil
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Ruch DS. An Excellent Study of Operative Versus Nonoperative Treatment of Humeral Shaft Fractures: Commentary on an article by Fabio Teruo Matsunaga, MD, PhD, et al.: "Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures. A Randomized Controlled Trial". J Bone Joint Surg Am 2017; 99:e36. [PMID: 28375900 DOI: 10.2106/jbjs.16.01609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David S Ruch
- Duke University Medical Center, Durham, North Carolina
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Bisaccia M, Meccariello L, Rinonapoli G, Rollo G, Pellegrino M, Schiavone A, Vicente CI, Ferrara P, Filipponi M, Caraffa A. Comparison of Plate, Nail and External Fixation in the Management of Diaphyseal Fractures of the Humerus. Med Arch 2017; 71:97-102. [PMID: 28790538 PMCID: PMC5511529 DOI: 10.5455/medarh.2017.71.97-102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/15/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Humeral shaft fractures are quite common in orthopedics and represent 1-3% of adult fractures. The surgical treatment is the a better choice in order to obtain a reduction and stable alignment and to prevent the complications. The goal of this study was to compare the three techniques (IMN, LCP and EF) in the treatment of diaphyseal fractures of the humerus in the adult patient. MATERIALS AND METHODS We examined 79 patients with diaphyseal fractures of the humerus. 32 were treated with plaque (LCP), 26 with intramedullary nail (IMN) and 21 with eternal fixer (FE) The clinical and radiographic follow-up was done at 1.3, 6 and 12 months. As rating scales we used the ASES and SF-36. We recorded all the complications. RESULTS The median follow-up was 11.5 months (9-16). The operative time was significantly smaller in the case of FE (47 ') with a statistically significant difference compared with other techniques. Even the blood loss was lower in the case of FE (60ml), compared to nails (160ml) and LCP (330ml) p <0.05. We had no differences in the duration of hospitalization and the ASES SF-36 score. We had 2 cases of non-union in the LCP group, 1 case in the IMN group and no cases in the FE group. In IMN group we had one case of radial transient paralysis. We did not have any deep infection, in the FE group 8 patients we had superficial secretions from pins. CONCLUSION From the results of our study, it is clear that the treatment of humeral shaft fractures guarantee overlapping results with the use of plates, of intramedullary nails, or with the external fixator. Consequently, the choice of which technique to use should be determined based on the experience of the operator and patient compliance.
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Affiliation(s)
- Michele Bisaccia
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
| | - Luigi Meccariello
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
| | - Giuseppe Rollo
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Marco Pellegrino
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
| | - Andrea Schiavone
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
| | - Cristina Ibáñez Vicente
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
| | - Pellegrino Ferrara
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
| | - Marco Filipponi
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Auro Caraffa
- Department of Orthopaedics and Traumatology, “S.M. Misericordia Hospital”, University of Perugia, Perugia, Italy
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Liu L, Zeng XT, Zhao JG. Regarding "Minimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials". J Shoulder Elbow Surg 2017; 26:e78. [PMID: 28160923 DOI: 10.1016/j.jse.2016.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/14/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Lin Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Xian-Tie Zeng
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Jia-Guo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
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Hohmann E, Glatt V, Tetsworth K. Response to letter to the editor regarding "Minimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials". J Shoulder Elbow Surg 2017; 26:e79-e80. [PMID: 28160924 DOI: 10.1016/j.jse.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Erik Hohmann
- Department of Orthopaedic Surgery, Clinical Medical School, University of Queensland, Brisbane, QLD, Australia.
| | - Vaida Glatt
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, QLD, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia; Orthopaedic Research Institute of Australia, Brisbane, QLD, Australia
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Mahajan AS, Kim YG, Kim JH, D'sa P, Lakhani A, Ok HS. Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers. Clin Orthop Surg 2016; 8:358-366. [PMID: 27904716 PMCID: PMC5114246 DOI: 10.4055/cios.2016.8.4.358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/11/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures in patients predominantly involved in overhead activities (athletes and manual laborers). METHODS Forty-eight patients fulfilling inclusion criteria were treated with ABP at a level-I trauma center using a 4.5-mm dynamic/locking compression plate and followed for a period of 1 year. Functional outcome was assessed using the Constant, Mayo elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Range of motion (ROM), subjective strength, and radiographic union were assessed. A general satisfaction questionnaire was also administered. RESULTS Most patients achieved excellent functional and radiological outcomes. ROM and strength of the shoulder girdle exhibited clinically nonsignificant loss as compared to the opposite side. The mean time for return to the original activities was 64 days (range, 36 to 182 days) and the mean time for confirmed radiographic union was 45 days (range, 34 to 180 days). The mean Constant, Mayo elbow, DASH scores were 95.73 ± 5.76 (range, 79 to 100), 95.94 ± 6.74 (range, 85 to 100), and 1.56 ± 3.15 (range, 0.0 to 14.0), respectively. The majority of patients (43 patients, 89.6%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (4.17%) of nonunion and 3 patients (6.25%) had to change/modify their original occupation. CONCLUSIONS ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It gives relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature causes minimal soft tissue damage and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures in patients predominantly engaged in overhead activities is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.
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Affiliation(s)
- Abhishek S Mahajan
- Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea
| | - Young Gun Kim
- Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea
| | - Jae Hwa Kim
- Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea
| | - Prashanth D'sa
- Department of Orthopaedics, Dr. V. M. Government Medical College & S. C. S. M. General Hospital, Solapur, India
| | - Azhar Lakhani
- Department of Orthopaedics, Dr. V. M. Government Medical College & S. C. S. M. General Hospital, Solapur, India
| | - Hyun Soo Ok
- Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea
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Dual plate fixation on distal third diaphyseal fracture of the humerus. INTERNATIONAL ORTHOPAEDICS 2016; 41:1655-1661. [DOI: 10.1007/s00264-016-3355-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Xue Z, Xu H, Ding H, Qin H, An Z. Comparison of the effect on bone healing process of different implants used in minimally invasive plate osteosynthesis: limited contact dynamic compression plate versus locking compression plate. Sci Rep 2016; 6:37902. [PMID: 27885262 PMCID: PMC5122854 DOI: 10.1038/srep37902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/02/2016] [Indexed: 12/18/2022] Open
Abstract
Minimally invasive plate osteosynthesis (MIPO) has been widely accepted because of its satisfactory clinical outcomes. However, the implant construct that works best for MIPO remains controversial. Different plate designs result in different influence mechanisms to blood flow. In this study, we created ulnar fractures in 42 beagle dogs and fixed the fractures using MIPO. The dogs were randomly divided into two groups and were fixed with a limited contact dynamic compression plate (LC-DCP) or a locking compression plate (LCP). Our study showed that with MIPO, there was no significant difference between the LCP and the LC-DCP in terms of fracture fixation, bone formation, or mineralization. Combined with the previous literature, we inferred that the healing process is affected by the quality of fracture reduction more than plate selection.
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Affiliation(s)
- Zichao Xue
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Haitao Xu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Haoliang Ding
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Hui Qin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
| | - Zhiquan An
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, China
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Hohmann E, Glatt V, Tetsworth K. Minimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2016; 25:1634-42. [PMID: 27522336 DOI: 10.1016/j.jse.2016.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/14/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to perform a meta-analysis comparing the clinical outcomes and complications between anterior humeral minimally invasive plate osteosynthesis (MIPO) and the 2 standard techniques, either open reduction and plating or humeral nailing. METHODS We performed a systematic review of Medline, Embase, Scopus, and Google Scholar to identify relevant randomized controlled trials in the English- and German-language literature. Eligibility criteria included randomized controlled trials comparing at least 1 surgical intervention with MIPO and reporting the primary clinical outcome using a validated functional scoring system and description of complications. Publication bias was assessed by funnel plot, and the risk of bias was established using the Cochrane Collaboration's Risk of Bias Tool. Heterogeneity was assessed using χ(2) and I(2) statistics. RESULTS Eight prospective randomized studies (N = 376) met the eligibility criteria and were included in the analysis. The pooled estimate for clinical outcome showed that MIPO resulted in a significantly better outcome (standardized mean difference, 0.366; 95% confidence interval, 0.16 to 0.571; P = .0001; I(2) = 61%). The pooled estimate for all complications showed that the open reduction-internal fixation/nail group had a significantly higher complication rate (odds ratio, 0.507; 95% confidence interval, 0.285 to 0.905; P = .021; I(2) = 97%). CONCLUSION Current evidence indicates the MIPO approach has better clinical outcomes with a lower rate of complications compared with alternative surgical techniques. However, the results of this meta-analysis are limited by problems inherent in the primary studies, including poor reporting of randomization protocols, as well as possible attrition bias and reporting bias, of the primary studies. Future publications may therefore change the trend of the pooled estimate in either direction.
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Affiliation(s)
- Erik Hohmann
- Clinical Medical School, University of Queensland, Brisbane, QLD, Australia.
| | - Vaida Glatt
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, QLD, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia; Orthopaedic Research Institute of Australia, Brisbane, QLD, Australia
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Zhang Q, Sun N, Huang Q, Zhu S, Wu X. Minimally Invasive Plating Osteosynthesis in the Treatment of Humeral Shaft Fractures: A Meta-Analysis. J INVEST SURG 2016; 30:133-142. [PMID: 27612003 DOI: 10.1080/08941939.2016.1215581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether minimally invasive plating osteosynthesis (MIPO) or other operative interventions is superior in the treatment of humeral shaft fractures remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the clinical outcomes of MIPO and other operative interventions in the treatment of humeral shaft fractures. METHODS Pubmed, Embase, and Web of Science were systematically searched to identify all available studies comparing clinical outcomes between patients receiving MIPO and other operative interventions. The weight mean difference (WMD) was pooled to compare the operative time, union time, University of California, Los Angeles (UCLA) score, and Mayo elbow performance index (MEPI).The risk ratio (RR) was pooled to compare the union rate, and incidence of complications. Pooled estimates were calculated by using a fixed-effects model or a randomized-effects model, according to the heterogeneity among studies. RESULTS Nine studies were included in this meta-analysis. Our results suggest that both MIPO and other operative interventions can achieve similar union time, UCLA score, MEPI, and union rate. However, MIPO is associated with better outcomes including shorter operation time, and lower incidence of radial nerve injury. CONCLUSION Evidence from this meta-analysis demonstrated that, MIPO is effective but safer than other operative interventions in the treatment of humeral shaft fracture. However, due to the potential limitations in this meta-analysis, randomized controlled trials with larger sample sizes using appropriate blinding methods are needed to confirm these findings.
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Affiliation(s)
- Quan Zhang
- a Department of Orthopedic Traumatology , Beijing Jishuitan Hospital , China
| | - Ning Sun
- a Department of Orthopedic Traumatology , Beijing Jishuitan Hospital , China
| | - Qiang Huang
- a Department of Orthopedic Traumatology , Beijing Jishuitan Hospital , China
| | - Shiwen Zhu
- a Department of Orthopedic Traumatology , Beijing Jishuitan Hospital , China
| | - Xinbao Wu
- a Department of Orthopedic Traumatology , Beijing Jishuitan Hospital , China
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Yu BF, Liu LL, Yang GJ, Zhang L, Lin XP. Comparison of minimally invasive plate osteosynthesis and conventional plate osteosynthesis for humeral shaft fracture: A meta-analysis. Medicine (Baltimore) 2016; 95:e4955. [PMID: 27684839 PMCID: PMC5265932 DOI: 10.1097/md.0000000000004955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The objective of this meta-analysis was to compare the efficacy and safety of minimally invasive plate osteosynthesis (MIPO) and conventional plate osteosynthesis (CPO) for humeral shaft fracture. METHODS Potential academic articles were identified from the Cochrane Library, Medline (1966-2016.3), PubMed (1966-2016.3), Embase (1980-2016.3), and ScienceDirect (1966-2016.3). Gray studies were identified from the references of the included literature. Randomized controlled trials (RCTs) and non-RCT involving MIPO and CPO for humeral shaft fracture were included. Two independent reviewers performed independent data abstraction. I statistic was used to assess heterogeneity. Fixed or random effects model was used for meta-analysis. RESULTS Two RCTs and 3 non-RCTs met the inclusion criteria. There was a lower incidence of iatrogenic radial nerve palsy in patients with MIPO (P = 0.006). There was no statistically significant difference in in the risk of developing nonunion, delay union, malformation, screw loosening, infection, operation time, UCLA, and MEPS function score between the 2 groups. CONCLUSION MIPO decreased incidence of iatrogenic radial nerve palsy and is an efficacy and safety technique for humeral shaft fracture. Due to the limited quality and data of the evidence currently available, more high-quality RCTs are required.
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Affiliation(s)
| | | | - Guo-jing Yang
- Department of Orthopedics, The Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province, People's Republic of China
- Correspondence: Guo-jing Yang, Department of Orthopedics, The Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province 325200, People's Republic of China (e-mail: )
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Xue Z, Jiang C, Hu C, Qin H, Ding H, An Z. Effects of different surgical techniques on mid-distal humeral shaft vascularity: open reduction and internal fixation versus minimally invasive plate osteosynthesis. BMC Musculoskelet Disord 2016; 17:370. [PMID: 27566069 PMCID: PMC5002093 DOI: 10.1186/s12891-016-1224-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Humeral shaft fractures are generally managed with the conventional posterior open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This study was aimed at comparing the outcomes of these surgical techniques in terms of the vascular integrity of the mid-distal humeral shaft. Methods Twelve upper limbs were harvested from 6 fresh cadavers. ORIF or MIPO was randomly performed on either side of each pair of limbs. The axillary artery was perfused with a latex-lead tetraoxide red solution to visualize the vascular structures. The vascular integrity of the humerus was examined by plain radiography and dissection. The periosteal filling achieved with each technique was scored and the scores compared. Results In each limb, one main nutrient artery entering the mid-distal humeral shaft anteromedially (83.3 %) or medially (16.7 %) was first identified. No case of injury to the main nutrient artery was noted for either surgical technique. Injuries to the accessory nutrient arteries entering the mid-distal humeral shaft from the posterior aspect were absent in the MIPO cases, but occurred in 52.9 % of the ORIF cases. In addition, MIPO was also superior to the open plate technique showed superior periosteal filling than. Conclusions Our results showed that the MIPO technique is superior to the ORIF in terms of preserving the vascular integrity of the mid-distal humeral shaft.
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Affiliation(s)
- Zichao Xue
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Shanghai, 200233, China
| | - Chaolai Jiang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Shanghai, 200233, China
| | - Chuanzhen Hu
- Department of Orthopaedic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Rui Jin Er Road, Shanghai, 200025, China
| | - Hui Qin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Shanghai, 200233, China
| | - Haoliang Ding
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Shanghai, 200233, China
| | - Zhiquan An
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Shanghai, 200233, China.
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Hu X, Xu S, Lu H, Chen B, Zhou X, He X, Dai J, Zhang Z, Gong S. Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis. J Orthop Surg Res 2016; 11:59. [PMID: 27169580 PMCID: PMC4864922 DOI: 10.1186/s13018-016-0394-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/04/2016] [Indexed: 01/29/2023] Open
Abstract
Background In this study, we performed a meta-analysis to identify whether minimally invasive plate osteosynthesis (MIPO) was superior to conventional fixation techniques (CFT) for treating humeral shaft fractures. Methods A systematic literature search was conducted up to February 2016 in ScienceDirect, Springer, MEDLINE, and PubMed databases for relevant papers that compared the outcomes of MIPO with CFT, such as open reduction with plate osteosynthesis (ORPO) and intramedullary nail (IMN) for treating humeral shaft fractures. Meta-analysis was performed with Review Manager 5.0 software. Results According to the search strategy, eight studies that covered 391 patients were enrolled, including four randomized controlled trials (RCTs), two prospective cohort trials, and two retrospective cohort trials. Our meta-analysis did not detect any significant difference between MIPO and CFT (IMN and ORPO) in terms of operative time, fracture union rate, and fracture union time. However, MIPO has a less rate of complications and iatrogenic radial nerve palsy than that of ORPO and higher adjacent joint function scores than those of IMN (p < 0.05). Conclusions Based on the present evidence, this meta-analysis suggested that MIPO was a better choice for treating humeral shaft fractures than CFT. However, more high-quality randomized trials are still needed to further confirm this conclusion in the future.
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Affiliation(s)
- Xuqi Hu
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Siqi Xu
- Department of Clinical Laboratory, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Huigen Lu
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Bao Chen
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Xiao Zhou
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Xiaojun He
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Jiaping Dai
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Zhongwei Zhang
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China
| | - Suiliang Gong
- Department of Orthopaedics, the Second Affiliated Hospital of Jiaxing University, 1518 Huancheng North Road, Jiaxing, China.
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Newly designed minimally invasive plating of a humerus shaft fracture; a different introduction of the plate. INTERNATIONAL ORTHOPAEDICS 2016; 40:2597-2602. [PMID: 26796548 DOI: 10.1007/s00264-015-3097-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Open reductions and internal fixations are currently being used the most in surgeries of humeral shaft fractures. However, there are some limitations such as invasive techniques and formation of many operation scars. To overcome these limitations, a minimally invasive plate osteosynthesis has been recently introduced. However, this has technical limitations such as deep dissections of the distal portion and narrowness of the fixation space. To address these problems, we designed another introductory technique of a minimally invasive osteosynthesis and we have examined the clinical usefulness of that. METHODS The results were retrospectively analyzed with 83 patients who visited INHA hospital due to a humeral shaft fractures and who had undergone the above said surgery from the beginning of 2010 to the end of 2012. The patients were divided into two groups: patients treated by the MIPO technique using the newly designed dual approaches (group A) and patients treated by open reduction and plating internal fixation (group B). RESULTS There was no significant difference in mean duration of injury, the mean fracture union time, range of motion and MEPI for group A and B. There was no statistical significance between the two groups. However, the occurrence of iatrogenic radial nerve palsy in group B, was significantly higher than in group A. CONCLUSIONS MIPOs using the dual approaches on the adult humerus shaft fracture show an excellent bony union without nerve injury which is clinically useful.
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Fu X, Tian P, Li ZJ, Sun XL, Ma XL. Postoperative leg position following total knee arthroplasty influences blood loss and range of motion: a meta-analysis of randomized controlled trials. Curr Med Res Opin 2016; 32:771-8. [PMID: 26783114 DOI: 10.1185/03007995.2016.1142431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM Postoperative leg position has been reported as an efficient and convenient technique to minimize blood loss and improve early recovery following total knee arthroplasty (TKA); however, no single study was large enough to definitively determine optimal leg position. Therefore, we performed a meta-analysis pooling the results from randomized controlled trials (RCTs) to evaluate the effect of postoperative leg position on blood loss and range of motion (ROM) in TKA. METHODS Potential academic articles were identified from the Cochrane Library, Medline (1966-October 2015), PubMed (1966-October 2015), Embase (1980-October 2015), ScienceDirect (1985-October 2015) and other databases. Gray studies were identified from the references of included literature reports. The pooling of data was analyzed by RevMan 5.1. RESULTS Ten RCTs were included in the meta-analysis. There were significant differences in the total blood loss (mean difference [MD] = -130.66, 95% CI: -198.74 to -62.57, P = 0.0002), hidden blood loss (MD = -73.27, 95% CI: -117.57 to -28.96, P = 0.001), blood transfusion requirement (risk difference [RD] = -0.10, 95% CI: -0.19 to -0.22, P = 0.02), postoperative hemoglobin level (MD = 0.73, 95% CI: 0.42 to 1.04, P < 0.00001) and range of motion (MD = 3.79, 95% CI: 1.43 to 6.14, P = 0.002) between the flexion group and extension group. No significant differences were found regarding length of hospital stay, deep vein thrombosis (DVT) and wound infection between the two groups. CONCLUSIONS This meta-analysis indicated that the postoperative flexion position of the leg in TKA was effective and safe, significantly decreasing total blood loss, hidden blood loss and blood transfusion requirement. In addition, the postoperative range of motion is significantly improved by the flexion position of the leg.
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Affiliation(s)
- Xin Fu
- a Tianjin Hospital , Tianjin , China
| | - Peng Tian
- a Tianjin Hospital , Tianjin , China
| | - Zhi-jun Li
- b General Hospital of Tianjin Medical University , Tianjin , China
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The outcomes of bridging high-energy humeral shaft fractures using a locking compression plate through an open approach. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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