Thrower's fracture of the humerus

Sports-related peripheral nerve injuries of the upper limb

Peripheral nerve injuries in athletes affect the upper limb more commonly than the lower limb. Common mechanisms include compression, traction, laceration, and ischemia. Specific sports can have unique mechanisms of injury and are more likely to be associated with certain neuropathies. Familiarity with these sport-specific variables and recognition of the common presentations of upper limb neuropathic syndromes are important in assessing an athlete with a suspected peripheral nerve injury. Evaluation may require imaging modalities and/or electrodiagnostic testing to confirm a nerve injury. In some cases, diagnostic injections may be needed to differentiate neuropathic versus musculoskeletal etiology. Early and accurate diagnosis is essential for treatment/management and increases the likelihood of a safe return-to-sport and avoidance of long-term functional consequences. Most nerve injuries can be treated conservatively, however, severe or persistent cases may require surgical intervention. This monograph reviews key diagnostic, management, and preventative strategies for sports-related peripheral nerve injuries involving the upper limb.

Humeral Fracture in a Young CrossFit Practitioner

CrossFit (CrossFit Inc, Washington, DC) is a recent, high-intensity strength and conditioning sport that is growing in popularity worldwide. Potential risks and injuries have been described in previous reports. Distal humeral fractures without direct trauma were related to sports like baseball or wrestling. However, they have never been reported in a CrossFit athlete. We present the first case of distal humeral fracture associated with a CrossFit workout, during a gymnastic movement. Our patient had no relevant medical history but the investigation revealed reduced vitamin D levels and low bone density. The patient was surgically treated and he completed the rehabilitation program. He returned to sports practice 12 weeks after the surgery.

Stress reactions and fractures around the elbow in athletes

Stress fractures of the upper limb affect athletes from a wide range of sports. Athletes involved in throwing sports are particularly susceptible along with athletes from sports involving high repetitive and compressive loads such as gymnastics. Diagnosis can be made from clinical history, examination and radiography in some cases however MRI imaging is often required for definitive diagnosis. The mainstay of management is rest and activity modification however advanced pathology often requires surgical management for successful resolution and return to play. In the elbow, the bones susceptible to excessive stress in sport are the distal humerus, the olecranon process of the ulna, the coronoid process of the ulna, the sublime tubercle and the radial head. In immature patients, medial epicondyle apophysis is the most common location. The article presents a narrative review of the literature.

Fracture Epidemiology in Professional Baseball From 2011 to 2017

Background:

Fractures are a significant cause of missed time in Major League Baseball (MLB) and Minor League Baseball (MiLB). MLB and the MLB Players Association recently instituted rule changes to limit collisions at home plate and second base.

Purpose:

To evaluate the epidemiologic characteristics of fractures in professional baseball and to assess the change in acute fracture incidence secondary to traumatic collisions at home plate and second base after the recently instituted rule changes.

Study Design:

Descriptive epidemiology study.

Methods:

The MLB Health and Injury Tracking System (HITS) database was used to access injury information on MLB and MiLB players to analyze fracture data from 2011 to 2017. Injuries were included if the primary diagnosis was classified as a fracture in the HITS system in its International Classification of Diseases, Ninth Revision, codes; injuries were excluded if they were not work related, if they occurred in the offseason, or if they were sustained by a nonplayer. The proportion of fractures occurring due to contact with the ground or another person in the relevant area of the field—home plate or second base—in the years before rule implementation was compared with the years after.

Results:

A total of 1798 fractures were identified: 342 among MLB players and 1456 among MiLB players. Mean time missed per fracture was 56.6 ± 48.4 days, with significantly less time missed in MLB (46.8 ± 47.7 days) compared with MiLB (59.0 ± 48.3 days) (P < .0001). A 1-way analysis of variance with post hoc Bonferroni correction demonstrated that starting pitchers missed significantly more time due to fractures per injury than all other position groups (P < .0001). Acute fractures due to contact with the ground or with another athlete were significantly decreased after rule implementation at home plate in 2014 (22 [3.0%] vs 14 [1.3%]; P = .015) and at second base in 2016 (90 [7.0%] vs 23 [4.5%]; P = .045).

Conclusion:

The recently instituted rule changes to reduce collisions between players at home plate and at second base are associated with reductions in the proportion of acute fractures in those areas on the field.

Humeral shaft fracture and radial nerve palsy in Korean soldiers: focus on arm wrestling related injury

INTRODUCTION

Humeral shaft fractures can lead to radial nerve injury and may require surgery and rehabilitation. We determined the causative events of humeral fracture, including arm wrestling, in young Korean soldiers and examined whether humeral fracture is related to demographic characteristics and the presence of radial nerve palsy.

METHODS

We reviewed 7.5 years (July 2012 to June 2019) of medical records covering patients who had experienced a humeral shaft fracture after entering military service and had received surgery for open reduction and internal fixation. Data were obtained on basic demographics, initial event provoking the fracture, presence of radial nerve palsy, initial and follow-up severity of the weakness, and any discharge from military service because of prolonged radial nerve palsy.

RESULTS

Of 123 cases, arm wrestling was the leading cause (52.8%). A high energy injury, such as falling from a height (11.4%), and sports related slips (10.6%) were other causes. All humeral shaft fractures caused by forceful contraction were spiral, while 40% of the fractures caused by external force related events were of a transverse type. The percentage of left-sided fractures was significantly higher for fractures arising from an external force than in those caused by forceful contraction related events. Radial nerve palsy was found in 34 patients (27.6%), and 16 were discharged from the military because of prolonged radial nerve palsy 6 months after the fracture. The causative events and other factors did not affect the presence of radial nerve palsy.

CONCLUSION

Arm wrestling was the leading cause of humeral fracture in young Korean soldiers but the chance of developing comorbid radial nerve palsy did not differ from that of other causes. These epidemiologic findings in this young active group may help in understanding the causes of humeral shaft fracture in soldiers and in the wider young population.

Operative treatment of torsional humeral shaft fractures in throwers leads to an earlier return to sport: a survey of expert shoulder and elbow surgeons

PURPOSE

To determine the management of torsional humeral shaft fractures in a group of expert shoulder and elbow surgeons and analyse the rate of return to sport of these throwing athletes.

METHODS

A survey was sent to all physician members of two prominent sports medicine professional associations: the American Shoulder and Elbow Surgeons and the Herodicus Society. Due to the rare nature of this injury, a historical survey of management and return to play was performed to allow analysis of trends in treatment and return to play after both non-operative and operative management.

RESULTS

The survey was emailed to 858 physician members. Out of the 95 respondents, 35 surgeons indicated they had treated ≥ 1 torsional humeral shaft fractures in throwing athletes (average 1.7 per surgeon). A total of 72 fractures were recorded with an average age of 20.4 years and the majority being male (68/72). Eighty-one percent (58/72) of the fractures were classified as simple spiral. Sixty-one percent (44/72) of the fractures were treated non-operatively, while 35% (25/72) of the fractures were treated by open reduction and internal fixation (ORIF). Patient age, return to sport rate and level, type of fracture, and fracture healing time did not significantly differ based on treatment type. Average time to return to sport was significantly shorter for patients who underwent ORIF compared to non-operative treatment (p = 0.001). Overall, 48 (92.3%) of the 52 athletes returned to sport, with 84% (36/43) returning to the same level of play.

CONCLUSION

Torsional humeral shaft fractures in throwers are most commonly seen in young men and can be treated both operatively and non-operatively with overall similar results for healing time, rate of non-union, and return to sport. The only significant difference in the groups was an earlier return to sports in those fixed surgically, however, operative intervention also yielded a higher complication rate. Regardless of the treatment method, the overall rate of return to play was moderate. These finding are clinically relevant and can assist physicians with decision making for treatment and can help when advising throwers of appropriate expectations for recovery after this injury.

LEVEL OF EVIDENCE

IV.

Humeral Fractures Sustained During Arm Wrestling: A Retrospective Cohort Analysis and Review of the Literature

Arm wrestling places significant torque on the humeral shaft. A spiral distal humeral shaft fracture is an unusual but significant injury that can result. Of 93 patients who presented between 2009 and 2017 with closed humeral shaft fractures that were managed nonoperatively, 9 sustained the fractures while arm wrestling. Outcomes were compared with those of all other patients with nonoperatively managed humeral shaft fractures sustained through other mechanisms. The Student's t test was used to compare cohorts. All patients had spiral fractures that occurred in the distal one-third of the humerus. All patients went on to achieve radiographic union after a mean of 13.6 weeks (95% confidence interval [CI], 11.5-15.6). At fracture healing, mean angulation of the humerus seen on the anteroposterior and lateral views was 15.1° (95% CI, 12.0°-18.2°) and 8.9° (95% CI, 3.7°-14.1°), respectively. Mean elbow flexion-extension arc was 141.1° (95% CI, 134.4°-147.8°), with mean forward shoulder elevation of 168.8° (95% CI, 153.3°-184.2°). On comparison of the patients with humeral shaft fractures sustained through arm wrestling with the patients with humeral shaft fractures sustained through other mechanisms, except for earlier time to healing for the former (P=.05), no significant differences were observed. This represents the first analysis of radiographic and clinical outcomes following these types of fractures. Those who sustain these fractures secondary to the high-torque moment of arm wrestling are not different from those who sustain these fractures secondary to other mechanisms, except for an earlier time to union. This study indicates that nonoperative management of all humeral shaft fractures results in radiographic union with favorable clinical outcomes. [Orthopedics. 2018; 41(2):e207-e210.].

Pathologies of the shoulder and elbow affecting the overhead throwing athlete

The overhead-throwing athlete is susceptible to a variety of predictable disease entities affecting the shoulder and elbow. While the pathophysiology and nomenclature of these diseases are ubiquitous throughout the clinical literature, this information is sparse within the radiology domain. We provide a comprehensive review of these unique injuries with accompanying imaging features in an effort to enhance the role of the radiologist during the management of the overhead thrower. When appropriately recognized and described, the imaging features aid in establishing a diagnosis and ultimately the implementation of appropriate clinical management.

Thrower's Fracture of the Humerus: An Investigation of Risk Factors Following an Unlikely Scenario: A Case Report

CASE

A 26-year-old amateur baseball player without prodromal arm pain sustained a thrower's fracture of the humerus on a warm-up throw performed with submaximal effort. The fracture occurred during the first throwing session following a 6-week layoff. The patient was treated nonoperatively and made a full recovery, but he elected to not return to throwing sports.

CONCLUSION

Because of the lack of risk factors in this case, we suggest that time off or irregularity in throwing may play a greater role in a thrower's fracture than previously established. Recreational throwers should undergo appropriate preseason training before returning to throwing.

Surgical result of plate osteosynthesis using a locking plate system through an anterior humeral approach for distal shaft fracture of the humerus that occurred during a throwing motion

PURPOSE

This paper analyzed outcomes of the osteosynthesis with a locking plate system for the fractures of the humerus in throwers using the anterior humeral approach.

METHODS

Retrospective case series including 31 patients. Bone union was assessed through follow-up radiographs. Results of visual analogue scale (VAS) for pain, range of motion in the elbow joint, time of return to work, and the Mayo Elbow Performance Score (MEPS) were evaluated to determine functional outcomes. Direction and length of the fracture, the distal cortical length, the humeral diameter, and the total humeral length were measured as part of fracture configuration analysis.

RESULTS

Mean patient age was 25.8 (range, 18-34) years. The follow-up average was 16.0 months (range, 12-23). Delayed union was observed in one (3.1 %) patient. Mean final VAS was 0.4 (range, 0-2), mean time of return to work was 18.2 weeks (range, 13-36), and mean MEPS was 96.3 (range, 88-100) points. All fractures showed a spiral configuration. Mean fracture length was 79.7 (95 % CI, 72.6-86.7) mm, and mean distal cortical length was 48.3 (95 % CI, 37.8-58.8) mm.

CONCLUSIONS

The results of the current study indicates that plate osteosynthesis using a locking plate system combined with interfragmentary lag screws through anterior humeral approach may be a favorable option for the surgical treatment of humeral shaft fractures in throwers.