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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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Karadeniz E, Demiroz S, Oktem F, Memisoglu K, Kesemenli CC. Humeral fractures sustained during arm wrestling. Eur J Trauma Emerg Surg 2022; 48:3109-3114. [PMID: 34981137 DOI: 10.1007/s00068-021-01852-4] [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: 09/12/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to present our experience of treating humerus fracture sustained during arm wrestling. METHODS Data of patients treated in our clinic with the diagnosis of humeral shaft fracture due to arm wrestling between 2000 and 2020 was retrospectively reviewed. Data collected included age, sex, dominant arm, history of professional or experienced participation, type and laterality of fracture, presence of radial nerve palsy, other surgical complications, management (surgical or conservative), duration of union defined as the time from injury until callus was evident on the radiograph, and the range of motion of the elbow joint at the last follow-up. RESULTS Nineteen patients with humeral shaft fracture as a result of the arm wrestling were included. All had right arm fracture and all had right as the dominant side. All of the fractures were spiral at the distal third of the humerus and medial butterfly fragment was present in eleven (57.9%). Seven (36.8%) were treated surgically. Five (26.3%) had radial nerve palsy on admission. At last follow-up, no patient had neural deficit and none had significant loss of range of movement. CONCLUSION Arm wrestling is an important cause of humerus shaft fracture. The dominant side is invariably affected. In this series all fractures were spiral type and occurred in the distal third of the humerus. One quarter of patients experienced radial nerve palsy, which can resolve spontaneously. Satisfactory results can be obtained with both conservative and surgical treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Emre Karadeniz
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Kocaeli, İzmit, 41001, Turkey
| | - Serdar Demiroz
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Kocaeli, İzmit, 41001, Turkey.
| | - Ferhat Oktem
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Kocaeli, İzmit, 41001, Turkey
| | - Kaya Memisoglu
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Kocaeli, İzmit, 41001, Turkey
| | - Cumhur Cevdet Kesemenli
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Kocaeli, İzmit, 41001, Turkey
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Pollock FH, Maurer JP, Sop A, Callegai J, Broce M, Kali M, Spindel JF. Humeral Shaft Fracture Healing Rates in Older Patients. Orthopedics 2020; 43:168-172. [PMID: 32077964 DOI: 10.3928/01477447-20200213-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
Nonoperative treatment has become the standard of care for the majority of humeral shaft fractures. Published studies have mainly come from trauma centers with a young cohort of patients. The purpose of this study was to determine the nonunion rate of humeral shaft fractures in patients older than 55 years. A retrospective study was performed on a group of orthopedic trauma group treated at a level I trauma center during a 10-year period (2007-2017). Patients 55 years or older and treated for a humeral shaft fracture nonoperatively, with or without manipulation, were identified. Nonunion was defined by no bridging callus radiographically or by gross motion at the fracture at least 12 weeks from injury. There were 31 patients identified with humeral shaft fractures who met the inclusion criteria. The cohort included 21 (67.7%) females and 10 (32.3%) males with a mean age of 72.5 years (range, 55-92 years). Twenty-one fractures went on to union, and there were 10 nonunions, with no significant differences in the demographics or comorbidities. There was no correlation between AO/OTA fracture classification or fracture location and union status. There was a tendency toward higher risk of nonunion in proximal third humeral shaft fractures (45%) compared with middle (26%) and distal third (20%) humeral shaft fractures, although this was not statistically significant. The overall nonunion rate for humeral shaft fractures was 32% for patients older than 55 years. The authors found a significant correlation between age and union rate: as age increased, union rate decreased (R=-0.9, P=.045). The incidence of humeral shaft nonunion in patients older than 55 years was significantly higher than that of younger adults. To the authors' knowledge, this study is the first to report a significant correlation between nonunion and increased age. [Orthopedics. 2020;43(3);168-172.].
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Kim KE, Kim EJ, Park J, Kim SW, Kwon J, Moon G. Humeral shaft fracture and radial nerve palsy in Korean soldiers: focus on arm wrestling related injury. BMJ Mil Health 2020; 167:80-83. [PMID: 32276967 DOI: 10.1136/bmjmilitary-2019-001373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Kyoung-Eun Kim
- Department of Rehabilitation Medicine, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - E-J Kim
- Department of Rehabilitation Medicine, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - J Park
- Department of Rehabilitation Medicine, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - S W Kim
- Department of Rehabilitation Medicine, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - J Kwon
- Department of Rehabilitation Medicine, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - G Moon
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Mayfield CK, Egol KA. Humeral Fractures Sustained During Arm Wrestling: A Retrospective Cohort Analysis and Review of the Literature. Orthopedics 2018; 41:e207-e210. [PMID: 29309719 DOI: 10.3928/01477447-20180102-05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
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.].
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