Locking compression plate fixation in humeral shaft fractures: A comparative study to literature conservative treatment

Humeral shaft fracture: systematic review of non-operative and operative treatment

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.

Evaluation of Functional and Radiological Outcomes of Humeral Shaft Fracture Treated With Locking Compression Plate

Background The best surgical procedure for humeral shaft fractures is still plate and screw fixation. Researchers have shown that plate fixation lessens the occurrence of malunion and nonunion. This study aims to describe the functional and radiological outcomes of a humerus shaft fracture treated with a locking compression plate (LCP) using the visual analog scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) scoring systems. Method From December 2020 to July 2022, 25 patients with humerus shaft fractures were enrolled in the prospective observational study at RL Jalappa Hospital, which is affiliated with Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar. We have included closed and open type 1 fractures as per the Gustilo-Anderson classification and excluded humerus shaft fractures associated with neurovascular injury, pathological fractures, and ipsilateral upper limb long bone (radius and ulna) fractures. For a humerus shaft fracture, open reduction and internal fixation (ORIF) + LCP was done on patients who were fit for surgery, had normal test results, and were given the right kind of anesthesia. Every six weeks, every three months, and every six months, patients had regular reviews. A check X-ray was taken each time a patient attended, and we assessed them clinically and radiologically for fracture union, functional outcome, and comorbidities. The patient's DASH and VAS ratings were assessed at the follow-up visit. The Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Armonk, NY, USA) was used to analyze the data. Result The mean age of the study participants was 33 years, with a standard deviation of 8.9 years. Among the study participants, about 60% of the individuals were males. About 40% of the individuals had injuries due to motorcycle accidents, and 88% of the individuals had direct injuries. Only 12% of the individuals had disease complications. This study recorded a 100% union rate among the study samples. Among the study participants who have histories of hypertension, closed fractures have shown significant improvement according to VAS scores. Among the study participants who were males, those who presented with indirect injury, no history of fracture, right side involvement, and absence of complications showed significant improvement according to the DASH score. Conclusion LCP is reliable for the union of fractures in patients of any age and activity level since we can use it at all levels of the humeral shaft and can achieve 100% union when used with the right principles and osteogenic stimulus. LCPs repair humeral shaft fractures well because they can achieve good functional and radiological results and have few adverse effects.