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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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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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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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Cen C, Cao Y, Zhang Y, Hu C, Luo C. Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures. J Orthop Surg Res 2022; 17:260. [PMID: 35551620 PMCID: PMC9097423 DOI: 10.1186/s13018-022-03149-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose Open reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative field and difficulty in locating the radial nerve, the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique via the posterior approach to treat middle-inferior humerus fractures has rarely been reported. This study aims to evaluate the clinical effect of the preoperative study of the radial nerve position by B-ultrasound and its intraoperative protection combined with MIPPO in managing middle-inferior humerus fractures. Methods The data were studied retrospectively involving 64 participants who had surgery for middle-inferior humerus fractures from the start of 2017 to the end of 2020. Participants were divided into two groups, those treated with the MIPPO technique, including newly developed dual procedures and preoperative position and protection of radial nerve by B-ultrasound (group A), and those treated with open reduction and internal plating fixation (group B). Results All the cases were followed up for 12–34 months (an average of 25.6 ± 8.76 months), and there was no significant difference in the mean operative duration, surgical incision infection, range of motion (ROM) and MEPS (Mayo elbow performance score) for groups A and B. However, the occurrence of complications (radial nerve palsy, bone nonunion and flexible internal fixation or ruptures) in group B was significantly higher than the group A. A statistically significant difference was observed in the intraoperative blood loss, hospital stay and fracture nonunion time between the two groups. All the cases gained bone union within the MIPPO group. Conclusion MIPPO via the posterior dual approach associated with preoperative position and protection of radial nerve by B-ultrasound does not increase radial nerve injury, however, it exhibits obvious advantages in the bone union, which is worthy of clinical application.
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Affiliation(s)
- Chaode Cen
- Department of Orthopedics, The Guizhou Provincial Orthopedic Hospital, Guiyang, 550014, Guizhou, China
| | - Yongfei Cao
- Department of Orthopedics, The Guizhou Provincial Orthopedic Hospital, Guiyang, 550014, Guizhou, China
| | - Yong Zhang
- Department of Gynaecology and Obstetrics, Guiyang First People's Hospital, Guiyang, 550002, Guizhou, China
| | - Chaoran Hu
- Department of Orthopedics, The Guizhou Provincial Orthopedic Hospital, Guiyang, 550014, Guizhou, China
| | - Chunshan Luo
- Department of Orthopedics, The Guizhou Provincial Orthopedic Hospital, Guiyang, 550014, Guizhou, China.
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Prakash L, Dhar SA. Non operative management of fractures of the humerus Evaluation of a new extension casting method. Acta Orthop Belg 2022; 88:151-159. [PMID: 35512166 DOI: 10.52628/88.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fractures of the humeral shaft represent 2-4% of all fractures and functional bracing is the gold standard in conservative management. Complications like restricted shoulder range of motion and malunion of the proximal shaft fractures have however been reported. We conducted a retrospective chart re- view of patients treated with the extension casting method over a period of 16 years. Topographically, Garnavos P, M, D, PM and MD fractures and morphologically Simple, Complex and Intermediate fractures were included. Between 2003 and 2019, 74 patients were treated with extension casting. The fractures united at a mean of 10 weeks and there was no case of non-union. Humerus is one of the bones where conservative methodology is still very pertinent. Extension casting gives reproducible and good results. It also addresses patient comfort issues to a considerable extent by allowing shoulder motion and easier maintenance of personal hygiene.
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Pothmann C, Neuhaus V, Pape HC, Simmen HP, Jensen K. Alternative and off-label use of Titanium Elastic Nail® in acute adult humeral diaphyseal and subcapital fractures. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Akalın Y, Şahin İG, Çevik N, Güler BO, Avci Ö, Öztürk A. Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2113-2121. [PMID: 32666240 DOI: 10.1007/s00264-020-04696-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/29/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the radiological and clinical outcomes of interlocking nail (ILN) and locking plate fixation (LCP) for humeral shaft fractures. METHODS A total of 63 patients with displaced humeral shaft fractures between October 2014 and January 2017 were evaluated prospectively. They were divided randomly into two as LCP fixation (group 1) and interlocking nail (ILN) (group 2). Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles (UCLA) shoulder scores, and Short Form-36 (SF-36) questionnaires, and pain was assessed with visual analogue scale (VAS). RESULTS After fracture callus was radiologically observed, DASH, ASES, and UCLA scores as well as SF-36 questionnaires and VAS results were noted to have no significant difference between the two groups (p = 0.109, p = 0.082, p = 0.146, p = 0.322, and p = 0.175, respectively). At the last follow-up (post-operative 24 months), the UCLA score was significantly better in group 1 (p = 0.034), whereas VAS result was significantly worse in group 2 (p = 0.017). DASH, ASES scores, and SF-36 questionnaires had no difference (p = 0.193, p = 0.088, p = 0.289). Other parameters revealed no significant differences. Fracture consolidation was observed at a mean of four months in both groups (3 to 7 months in group 1 and 3 to 8 months in group 2) (p = 0.189). Four patients in group 1 and five patients in group 2 underwent surgery for nonunion (p = 0.725). Post-operative radial nerve palsy was seen in one patient in group 2. Two patients in group 1 with superficial infection were treated with antibiotics, and they recovered. CONCLUSIONS Regarding our results, the LCP group had significantly better shoulder function than the ILN group, whereas the ILN group had significantly less pain, with similar complication rates. Therefore, both procedures are favourable surgical options for patients with humeral shaft fractures.
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Affiliation(s)
- Yavuz Akalın
- Bursa Yuksek Ihtisas Training and Research Hospital, Department of Orthopaedics and Traumatology, University of Health Sciences, 16310, Yıldırım, Bursa, Turkey. .,Bursa Yuksek Ihtisas Training and Research Hospital, Department of Orthopaedics and Traumatology, University of Health Sciences, 16310, Yıldırım, Bursa, Turkey.
| | - İsmail Gökhan Şahin
- Turkish Ministry of Health, Edirne Sultan 1. Murat Devlet Hastanesi, Department of Orthopaedics and Traumatology, 22100, Edirne, Turkey
| | - Nazan Çevik
- Bursa Yuksek Ihtisas Training and Research Hospital, Department of Orthopaedics and Traumatology, University of Health Sciences, 16310, Yıldırım, Bursa, Turkey
| | - Burak Olcay Güler
- Bursa Yuksek Ihtisas Training and Research Hospital, Department of Orthopaedics and Traumatology, University of Health Sciences, 16310, Yıldırım, Bursa, Turkey
| | - Özgür Avci
- Bursa Yuksek Ihtisas Training and Research Hospital, Department of Orthopaedics and Traumatology, University of Health Sciences, 16310, Yıldırım, Bursa, Turkey
| | - Alpaslan Öztürk
- Bursa Yuksek Ihtisas Training and Research Hospital, Department of Orthopaedics and Traumatology, University of Health Sciences, 16310, Yıldırım, Bursa, Turkey
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Ferrara F, Biancardi E, Touloupakis G, Bibiano L, Ghirardelli S, Antonini G, Crippa C. Residual interfragmentary gap after intramedullary nailing of fragility fractures of the humeral diaphysis: short and midterm term results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:432-438. [PMID: 31910167 PMCID: PMC7233757 DOI: 10.23750/abm.v90i4.7315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022]
Abstract
The purpose of this retrospective study was to evaluate the short and midterm radiological outcome with regards to bone healing, correlated with humeral shaft fractures treated with anterograde intramedullary nailing, when interfragmentary gap was significant. Here, we critically review our experience of short and midterm term results in over 65 year-old patients. Inclusion criteria in the study were: (1) patients over 65 years old (2) patients with displaced humeral mid shaft fractures (AO/OTA 12 A B C type fractures); (3) patients treated with closed reduction and internal fixation with intramedullary nail (Trigen Humeral Nail® Smith and Nephew) with at least two screws for proximal locking and one screw for distal locking; (4) residual interfragmentary gap, being considered significant any gap >6 mm (being 7 mm the minimum nail diameter available in our facility). Various factors were considered in our analysis: the size of the interfragmentary gap in both projections (also the mean of the measured gaps was calculated), the relationship between the greater and the mean interfragmentary gap and the second diameter measurement of the nail in the half distal part, the number of the screws in distal locking procedure, the use of a reaming procedure or not, the AO classification, the actual age at the time of surgery, the operating time, the nail second diameter as described before and its ratio with the measured residual gap. At 3 months follow-up, 4 patients showed radiographic healing (26,67%), 9 patients showed a visible callus (60%), with a total of 13 patients (86,67%) showing signs of normal recovery, the remaining 2 patient had insufficient callus formation (13,3%). At 6 months follow-up, 1 patient was missing (6,67%), although radiographic healing was already evident during the previous follow-up check, another one showed incomplete callus formation, the remaining 13 patients showed radiographic healing (86,67%), with a total of 14 patient considered healed at 6 months follow-up (93,33%). In conclusion, osteosynthesis with anterograde nail in geriatric patients appears to be a quite safe approach despite a great interfragmentary gap. After 6 months of treatment, callus formation and the overall clinical outcome were proven to be above satisfaction. (www.actabiomedica.it).
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Affiliation(s)
- Fabrizio Ferrara
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital (Milan, Italy).
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Vidović D, Benčić I, Ćuti T, Gajski D, Čengić T, Bekić M, Zovak M, Sabalić S, Blažević D. TREATMENT OF HUMERAL SHAFT FRACTURES: ANTEGRADE INTERLOCKING INTRAMEDULLARY NAILING WITH ADDITIONAL INTERLOCKING NEUTRALIZATION SCREWS THROUGH FRACTURE SITE. Acta Clin Croat 2019; 58:632-638. [PMID: 32595248 PMCID: PMC7314309 DOI: 10.20471/acc.2019.58.04.10] [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] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to compare union time between two different nail designs for the treatment of humeral shaft fracture, i.e. antegrade interlocking intramedullary nail with and without additional interlocking neutralization screws. The retrospective study included 51 patients treated with antegrade humeral intramedullary nailing between January 2015 and December 2017. The inclusion criteria of the study were proximal and middle third humeral shaft fractures. Fifty-one patients met the inclusion criteria; 23 patients were treated with antegrade intramedullary nail with additional interlocking neutralization screws through fracture site (group A) and 28 patients were treated with antegrade intramedullary nail without additional interlocking neutralization screws (group B). Medical documentation and radiographic images taken preoperatively and postoperatively were reviewed. Radiological union was defined as cortical bridging of at least three of four cortices in two-plane radiographs, with disappearance of the fracture gap. There were no significant differences in union time between the groups (p>0.05). To our knowledge, this is the first report of antegrade interlocking humeral nailing with additional interlocking neutralization screws through fracture site. Hypothetical advantages of fracture gap reduction by additional interlocking neutralization screws to promote union were not confirmed by this first clinical trial.
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Affiliation(s)
| | - Ivan Benčić
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tomislav Ćuti
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Domagoj Gajski
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tomislav Čengić
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marijo Bekić
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Mario Zovak
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Srećko Sabalić
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Dejan Blažević
- 1Department of Traumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Surgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5School of Medicine, University of Split, Split, Croatia; 6University of Applied Health Sciences, Zagreb, Croatia; 7Orthopedic and Traumatology Department, Dubrovnik General Hospital, Dubrovnik, Croatia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Verma A, Kushwaha SS, Khan YA, Mohammed F, Shekhar S, Goyal A. Clinical Outcome of Treatment of Diaphyseal Fractures of Humerus Treated by Titanium Elastic Nails in Adult Age Group. J Clin Diagn Res 2017; 11:RC01-RC04. [PMID: 28658858 DOI: 10.7860/jcdr/2017/26449.9812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/20/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Humerus shaft fracture is one of the most common injuries to the musculoskeletal system, which are managed both conservatively and surgically. There are pitfalls, advantages and disadvantages in each method. The individual fracture analysis determines the therapeutic options. AIM To assess the clinical outcome of treatment of diaphyseal fractures of humerus treated by Titanium elastic nail in adult age group by DASH scoring. MATERIALS AND METHODS It was a prospective study of 20 cases of diaphyseal fracture of humerus admitted to Era's Lucknow Medical College and Hospital between October 2014 and September 2015 treated with close reduction and internal fixation with titanium elastic nail. Functional outcome was evaluated using DASH scoring system and radiological outcome was evaluated by serial radiographs. The data was processed with SPSS software version 16.0 (Chicago, inc. USA) and it was summarized in proportion and percentage. RESULTS In our series of 20 patients, 17 were males and three were females. Most of the patients were between 30-50 years of age (mean 38 years). Most common mode of injury, side of involvement, level of fracture and fracture type were road traffic accidents (60%), right side (53.3%) and mid one third (75%), transverse (60%) respectively. So, in 65% of the patients, there was no disability of arm shoulder and hand as DASH score was within normal range and in 15% of the patients the disability was mild to moderate as scoring was slightly higher than normal and in 20% the disability was severe as the DASH score could not be calculated because of non union. CONCLUSION Elastic nail fixation require very minimal soft tissue dissection and being a close reduction, the biology of the fracture is also not disturbed and the chances of nerve injury are much less and as the non union was seen in oblique and spiral fracture type hence it should be used with caution or else other alternative methods of fixation should be used.
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Affiliation(s)
- Amit Verma
- Assistant Professor, Department of Orthopaedics, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Sudhir Shyam Kushwaha
- Assistant Professor, Department of Orthopaedics, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Yasir Ali Khan
- Assistant Professor, Department of Orthopaedics, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Farid Mohammed
- Associate Professor, Department of Orthopaedics, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Subhanshu Shekhar
- Junior Resident, Department of Orthopaedics, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Ankur Goyal
- Junior Resident, Department of Orthopaedics, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
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