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Moldovan F. Correlation between Peripheric Blood Markers and Surgical Invasiveness during Humeral Shaft Fracture Osteosynthesis in Young and Middle-Aged Patients. Diagnostics (Basel) 2024; 14:1112. [PMID: 38893638 PMCID: PMC11171808 DOI: 10.3390/diagnostics14111112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment for humeral shaft fractures (HSFs) is still controversial, consisting of a wide variety of orthopedic osteosynthesis materials that imply different grades of invasiveness. The aim of this study is to investigate the correlation between inflammatory blood-derived markers and the magnitude of the surgical procedure in young and middle-aged patients who sustained these fractures. Observational, retrospective research was conducted between January 2018 and December 2023. It followed patients diagnosed with recent HFSs (AO/OTA 12-A and B) and followed operative treatment. They were split in two groups, depending on the surgical protocol: group A, operated by closed reduction and internal fixation (CRIF) with intramedullary nails (IMNs), and group B, operated by open reduction and internal fixation (ORIF) with dynamic compression plates (DCPs). Statistically significant differences (p < 0.05) between the two groups could be observed in injury on the basis of surgery durations, surgical times, pre- and postoperative neutrophil-per-lymphocyte ratio (NLR), postoperative platelet-per-lymphocyte ratio (PLR), monocyte-per-lymphocyte ratio (MLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI) and aggregate inflammatory systemic index (AISI). The multivariate regression model proposed revealed that NLR > 7.99 (p = 0.007), AISI > 1668.58 (p = 0.008), and the surgical times (p < 0.0001) are strongly correlated to the magnitude of the surgical protocol followed. Using receiver operating characteristic (ROC) curve analysis, a balanced reliability was determined for both postoperative NLR > 7.99 (sensitivity 75.0% and specificity 75.6) and AISI > 1668.58 (sensitivity 70.6% and specificity 82.2%). Postoperative NLR and AISI as inflammatory markers are highly associated with the magnitude of surgical trauma sustained during humeral shaft fracture osteosynthesis in a younger population.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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Lopiz Y, Garriguez-Pérez D, Román-Gómez J, Scarano-Pereira JP, Ponz-Lueza V, García-Fernandez C, Marco F. Shoulder problems after percutaneous antegrade intramedullary nailing in humeral diaphyseal fractures using contemporary straight third-generation nail. J Shoulder Elbow Surg 2023; 32:2317-2324. [PMID: 37245620 DOI: 10.1016/j.jse.2023.04.012] [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: 01/13/2023] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Antegrade intramedullary nailing in humeral shaft fracture has been abandoned by certain orthopedic surgeons because of rotator cuff injury caused by first- and second-generation intramedullary nails (IMNs). However, only a few studies have specifically addressed the results of antegrade nailing for the treatment of humeral shaft fractures with a straight third-generation IMN; thus, complications need to be re-evaluated. We hypothesized that fixation of displaced humeral shaft fractures with a straight third-generation antegrade IMN with the percutaneous technique avoid shoulder problems (stiffness and pain) incurred by first- and second-generation IMNs. METHODS This was a retrospective, single-center, nonrandomized study of 110 patients with a displaced humeral shaft fracture between 2012 and 2019 treated surgically with a long third-generation straight IMN. Mean follow-up was 35.6 months (range, 15-44 months). RESULTS There were 73 women and 37 men with a mean age of 64.7 ± 19 years. All fractures were closed (37.3% 12A1, 13.6% 12B2, and 13.6% 12B3 AO/OTA classification). Mean Constant score was 82 ± 19, Mayo Elbow Performance Score 96 ± 11 and the mean EQ-5D visual analog scale score was 69.7 ± 21.5. Mean forward elevation 150° ± 40°, abduction 148° ± 45°, and external rotation 38° ± 15°. Symptoms associated with rotator cuff disease were present in 6.4%. Evidence of radiographic fracture healing was detected in all but 1 case. One postoperative nerve injury and 1 adhesive capsulitis were present. Overall, 6.3% underwent second surgeries (4.5% were minor surgeries like hardware removal). CONCLUSION Percutaneous antegrade intramedullary nailing of humeral shaft fractures with a straight third-generation nail considerably reduced complications related to shoulder problems and achieved good functional results.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain.
| | - Daniel Garriguez-Pérez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Julia Román-Gómez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Juan Pablo Scarano-Pereira
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Virginia Ponz-Lueza
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernandez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain
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Higashi JH, dos Reis FCC, Guimarães CFA, de Lima RD, Andrade-Silva FB, Silva JDS, Kojima KE. HUMERAL SHAFT FRACTURE WITH AN INTACT WEDGE FRAGMENT: MIPO VS CONVENTIONAL PLATING. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268121. [PMID: 37720807 PMCID: PMC10502979 DOI: 10.1590/1413-785220233103e268121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/17/2023] [Indexed: 09/19/2023]
Abstract
Objectives Evaluate bone healing time, consolidation, and the complication rate between the minimally invasive plate osteosynthesis and open reduction with plate osteosynthesis in humeral diaphyseal fractures with an intact wedge (AO 12B2). Methods A retrospective study was carried out between 2016 and 2020. The medical records and radiographs of 18 patients were analyzed, and data were collected regarding the time of consolidation, age, sex, plate size, number of screws, complications such as iatrogenic injury damage to the radial nerve, material failure, and postoperative infection. Results No statistically significant differences were observed in the variables of age, sex, plate size, and number of screws used or in the RUSHU index (Radiographic Union Score for Humeral fractures). There were no postoperative infections, material failure, or need for reoperation, nor cases of secondary radial nerve injury. After one year, all patients had a consolidation index analyzed by RUSHU >11. Conclusion both techniques showed similar results, with a high consolidation rate and low rates of complications or iatrogenic damage to the radial nerve. Evidence level III; Retrospective comparative study .
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Affiliation(s)
- Jorge Henrique Higashi
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Felipe Cruz Caetano dos Reis
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Caio Filipe Antunes Guimarães
- Universidade José do Rosário Vellano, Alfenas, MG, Brazil
- Santa Casa de Misericórdia de São Sebastião do Paraíso, São Sebastiao do Paraiso, MG, Brazil
| | - Ricardo Debussulo de Lima
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Fernando Brandao Andrade-Silva
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Jorge dos Santos Silva
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Kodi Edson Kojima
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
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Egrise F, Clowez G, Recanatesi N, Tabutin J, Borge PE, Gastaud O. Intramedullary nailing for humeral shaft fractures: Is distal locking necessary? Orthop Traumatol Surg Res 2023; 109:103437. [PMID: 36241138 DOI: 10.1016/j.otsr.2022.103437] [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: 02/06/2021] [Revised: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Intramedullary (IM) nailing of humeral shaft fractures is a reliable means to achieve bone union while allowing early motion. The hypothesis was that distal locking is unnecessary due to good primary stability of the impacted nail in the distal, truncated cone portion of the medullary canal. The primary objective of this study was to confirm the success of the procedure without distal locking by identifying failure criteria. The secondary objectives were to compare the outcomes of IM nailing with and without distal locking. MATERIAL AND METHODS This was a retrospective, single-center, non-randomized study of 128 patients with a humeral shaft fracture between 2012 and 2020 treated surgically with a long IM nail. Proximal locking was done in every case, then the rotational stability of the nail was tested. Stable nails were not locked distally (group A), while unstable nails were locked distally through an anterior approach (group B). All patients were reviewed with at least 12 months' follow-up. RESULTS Distal locking was performed in 30 patients (mean age 63, 17-91) while the fracture in 98 patients (mean age 65, 20-93) did not require distal locking. The average time to union was 4 months (2-6). The average operative time in group B was 87min (35-185) with 90s fluoroscopy time (33-158) versus 52min (20-127) with 44 s fluoroscopy time (12-143) in group A (p<0.05). Four patients in group B suffered postoperative radial nerve palsy and two others had another fracture at the level of the distal locking screws. The union rate did not differ between groups (Group A 94.6%, group B 86.2%, p=0.217) nor did the functional recovery - SSV of 79.5 (10-100) in group A versus 76 (40-100) in group B (p=0.271) - or the range of motion (p>0.05). There were no instances of rotational malunion. DISCUSSION Except for certain distal third fractures, distal locking is not necessary to achieve bone union when the nail is impacted into the medullary canal. This reduces the operative time, fluoroscopy time and risk of neurological damage. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- François Egrise
- Service de chirurgie orthopédique et traumatologie, Centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France.
| | - Gilles Clowez
- Service de chirurgie orthopédique et traumatologie, Centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - Nicolas Recanatesi
- Service de chirurgie orthopédique et traumatologie, Centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - Jacques Tabutin
- Service de chirurgie orthopédique et traumatologie, Centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - Paul Emile Borge
- Service de chirurgie orthopédique et traumatologie, Centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - Olivier Gastaud
- Service de chirurgie orthopédique et traumatologie, Centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
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Massin V, Laumonerie P, Bonnevialle N, Le Baron M, Ollivier M, Flecher X, Argenson JN, Lami D. What treatment for humeral shaft non-union? Case-series assessment of a strategy. Orthop Traumatol Surg Res 2023; 109:103532. [PMID: 36572380 DOI: 10.1016/j.otsr.2022.103532] [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: 02/09/2022] [Revised: 08/05/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Humeral shaft non-union is frequent, with severe clinical impact. Management, however, is poorly codified and there is no clear decision-tree. HYPOTHESIS Analyzing our experience over the last 15years could enable a reproducible strategy to be drawn up, with a decision-tree based on the 2 main causes: failure of internal fixation, and infection. MATERIAL AND METHOD Sixty-one patients were included in a retrospective cohort, with a mean 94 months' follow-p. The treatment strategy was based on screening first for infection then for mechanical stability deficit in case of prior internal fixation. Any fixation revision was associated to cancellous autograft. In case of suspected or proven infection, 2-stage treatment was implemented. In case of primary non-operative treatment, the strategy was based on the non-union risk on the Non-Union Scoring System (NUSS), with internal fixation and possible graft. RESULTS There were 6 failures, for a consolidation rate of 90%; excluding patients not managed according to the study protocol, the consolidation rate was 95%. There was 1 case of spontaneously resolving postoperative radial palsy, and 3 patients required surgical revision. DISCUSSION The present strategy achieved consolidation in most cases, providing the surgeon with a decision-tree for these patients. Infectious etiologies are often overlooked and should be a focus of screening. LEVEL OF EVIDENCE IV, retrospective or historical series.
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Affiliation(s)
- Valentin Massin
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
| | - Pierre Laumonerie
- Service de chirurgie orthopédique, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Nicolas Bonnevialle
- Service de chirurgie orthopédique, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Marie Le Baron
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Flecher
- Service de chirurgie orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Damien Lami
- Institut du Mouvement et de l'Appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, Pôle Locomoteur, Assistance-Publique Hôpitaux de Marseille, Marseille, France
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Mäder M, Tille E, Nowotny J, Kamin K, Schaser KD. [Therapy of Humeral Shaft Fractures]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:455-472. [PMID: 37506690 DOI: 10.1055/a-1958-6044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Humeral shaft fractures are a rare but challenging entity of injuries of the upper extremity. Despite all advances in the past decades - including improved imaging, adjusted surgical techniques and new implant designs - the treatment of humeral shaft fractures and especially the treatment choice remains challenging. Treatment options need to be evaluated individually under consideration of fracture morphology, soft tissue and potential neurological damage as well as patient-specific factors (i.e., age, comorbidities). Moreover, the risk of common complications such as radial nerve palsy, infection, non-union and malrotation needs to be evaluated in order to facilitate the best possible therapy for each patient. The regular available treatment options include conservative (cast, brace, etc.) and surgical measures (ante- and retrograde nailing, angle-stable plate osteosynthesis). Furthermore, (temporary) external fixation remains an option in emergency and complicative cases. However, none of the aforementioned options have proven a superior gold standard. This review evaluates the currently available treatment options and their individual advantages as well as the probability of possible complications and is aiming to supply a guide for individual treatment choice.
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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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Saracco M, Fulchignoni C, Fusco F, Logroscino G. WHICH SURGICAL TREATMENT IS PREFERABLE IN HUMERAL DIAPHYSEAL FRACTURES? A SYSTEMATIC REVIEW. Orthop Rev (Pavia) 2022; 14:37575. [PMID: 36034729 PMCID: PMC9404283 DOI: 10.52965/001c.37575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
INTRODUCTION Humeral diaphyseal fractures are very common. Many treatments have been proposed but the choice of the best one is often complex. OBJECTIVE The aim of the proposed study is to analyze the data in the literature in order to define the risks, advantages and disadvantages of the alternative surgical treatments (anterograde/retrograde intramedullary nailing, ORIF, MIPO). METHODS PubMed / Medline and Google Scholar were searched for prospective randomized or case-control retrospective studies about surgical treatment of humeral diaphyseal fractures with nailing, ORIF and MIPO, according to PRISMA guidelines. The primary outcome considered was the fracture healing time by comparing nailing-ORIF, nailing-MIPO and ORIF-MIPO. Differences in the rate of post-operative complications, patient satisfaction, intra-operative blood loss and surgical time were considered secondary outcomes. RESULTS 506 studies were identified, but only 10 studies were valid for the systematic review. No differences between nailing, ORIF and MIPO were recorded in terms of healing and surgical times. Intra-operative blood loss was significantly higher during ORIF (p 0.024). No differences were found in the restoration of function evaluated using clinical scales. The rate of complications was 27.4% for nailing, 21.2% for ORIF and 13.8% for MIPO. The difference was statistically significant only by comparing nailing with MIPO (p 0.012), probably because anterograde nailing is more often correlated to shoulder impairment. ORIF was at higher risk of infection compared to nailing (p 0.007). CONCLUSION Humeral diaphyseal fractures require careful pre-operative planning, ensuring reduced healing time, less soft tissue damage and low rate of complications. The lower exposure of the fracture allows for excellent results with reduced bleeding and lower risk of complications.
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Affiliation(s)
- Michela Saracco
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camillo Fulchignoni
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Fusco
- Department of Orthopaedics and Trauma, Osp. "San Giovanni di Dio" - ASL Napoli 2 Nord, Napoli, Italy
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Beeres FJP, van Veelen N, Houwert RM, Link BC, Heng M, Knobe M, Groenwold RHH, Babst R, van de Wall BJM. Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies. Eur J Trauma Emerg Surg 2021; 48:2667-2682. [PMID: 34219193 DOI: 10.1007/s00068-021-01728-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/08/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This meta-analysis compares open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures with regard to union, complications, general quality of life and shoulder/elbow function. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL was searched for observational studies and randomised clinical trials (RCT). Effect estimates were pooled across studies using random effects models. Results were presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95% CI). Subgroup analysis was performed stratified for study design (RCTs and observational studies). RESULTS Eighteen observational studies (4906 patients) and ten RCT's (525 patients) were included. The pooled effect estimates of observational studies were similar to those obtained from RCT's. More patients treated with nailing required re-intervention (RD 2%; OR 2.0, 95% CI 1.0-3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD 2%; OR 0.4, 95% CI 0.3-0.6). Notably, all but one of the radial nerve palsies resolved spontaneously in each groups. Nailing leads to a faster time to union (mean difference - 1.9 weeks, 95% CI - 2.9 to - 0.9), lower infection rate (RD 2%; OR 0.5, 95% CI 0.3-0.7) and shorter operation duration (mean difference - 26 min, 95% CI - 37 to - 14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores. CONCLUSION Nailing carries a lower risk of infection, postoperative radial nerve palsy, has a shorter operation duration and possibly a shorter time to union. Shoulder impingement requiring re-intervention, however, is an inherent disadvantage of nail fixation. Notably, absolute differences are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities.
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Affiliation(s)
- Frank Joseph Paulus Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - Nicole van Veelen
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - Roderick Marijn Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Björn Christian Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, USA
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | | | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bryan Joost Marinus van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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