BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular struct...BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.展开更多
Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar...Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.展开更多
There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surger...There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surgery for the left side and conservative treatment for the right side. The patient was a 73-year-old woman who had been diagnosed with PD 10 years prior to presentation. Open reduction internal fixation was conducted for the left proximal humeral fracture. 7 months after the left shoulder fracture, she fell resulting in a right proximal humeral fracture for which she underwent conservative treatment. Although bone union was obtained bilaterally, anterior subluxation occurred in the operated side 9 months postoperative. Screw remove was performed because perforation of the screw was observed in the humeral head and was causing pain. Currently, restriction in range of motion and subluxation may be seen on the side that received conservative treatment, although pain is absent and patient satisfaction is high. On the operated side, there is a marked restriction in range of motion, subluxation, and pain. Our experience revealed that conservative treatment was effective for proximal humeral fractures and that optimal bone union might be obtained even in patients with suboptimal PD control.展开更多
BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges f...BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.展开更多
Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared t...Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.展开更多
BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the man...BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.展开更多
Background Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors t...Background Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors that have an influence on the complications experienced after proximal humeral fractures fixed by locking plates and compare the results from patients having complications with those having no complications. Methods From September 2004 to September 2007, 92 out of 111 displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate were available for follow-up, with an average time of 15.2 months （12-36 months）. The range of motion, Visual Analog Score （VAS） for pain, American Shoulder and Elbow Surgeons＇ Form （ASES）, Constant-Murley, University of California-Los Angles scoring system （UCLA） score, and Simple Shoulder Test （SST） for function evaluation was all recorded at the latest follow-up. The results from patients with complications were evaluated according to the indices listed above and compared with those patients without any complications. Results There were 17 patients with complications, an 18.5% complication rate. Among them, the forward flexion, external rotation and internal rotation were 139.1°±24.3°, 24.1°±19.6°, and up to T10 level on average. The mean VAS score was 1.0±1.1, the ASES score was 82.9±13.8, the Constant 82.1±11.8, the UCLA 28.5±4.1 and the mean SST 9.5 on average. There was no significant difference of complication rate among different age, sex, and injured side, fresh or delayed fracture, combined with other injury or not groups. Compared with the group without complications, patients with complications showed significantly less external rotation and lower Constant-Murley and UCLA functional scores （P 〈0.05）. A significant difference in results was seen between patients with complications and those without complications. Conclusion The indication control and appropriate surgical technique were important while performing the locking plate fixation for proximal humeral fractures.展开更多
The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures.From January 2012 to December ...The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures.From January 2012 to December 2015,80 cases of senile patients with osteoporotic proximal humeral fractures were randomly divided into an observation group and a control group,each group with a total of 40 cases.The control group was simply treated with locking plate.The observation group was treated with locking plate in combination with biomimetic mineralized collagen putty.The therapeutic effect thereby was observed.The excellent and satisfactory rate was 90%in observation group and was 72.5%in control group.The difference between the two groups was statistically significant(χ^(2)=5.3312,P<0.05).The fracture healing time was 11.8263.62 weeks in observation group and 19.7865.46 weeks in control group.The shoulder joint function score was 89.6368.12 in observation group and 76.9268.18 in control group.There was significant difference between the two groups(t=7.1272;12.7834,P<0.05).The complication rate was 10%in the observation group and 32.5%in the control group(χ^(2)=7.3786,P<0.05).Locking system strengthened by biomimetic mineralized collagen putty has advantages such as accelerating healing of senile proximal humeral fracture,improving the therapeutic effect,reducing the complications.As one of the optimal internal fixation method,it provides a new option for better treatment of senile osteoporotic fracture.展开更多
Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total...Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total of 55 patients who suffered from com-plex proximal humeral fractures were treated by shoulder hemiarthroplasty. The mean age was 55.6 years and mean follow-up period was 25.1 months. The scoring system modi-fication for hemiarthroplasty (SSMH) had been adopted for evaluation at the latest follow-up.Results: The pain was obviously relieved in all patients. Fifty patients were painless and 5 patients had slight pain. The mean range of motion was 100°(90°-110°) in abduction, 95°(80°-100°) in forward flexion, 35°(30°-40°) in extemal rotation and internal rotation was confined at L2 level (L1-L3). The mean SSMH score was 27.9 (24-29). Fifty patients (90.1%) were satisfied with the clinical outcome.Conclusions: Shoulder hemiarthroplasty is an effective method to treat complex proximal humeral fractures. The proper selection of patients and prosthesis, good operation skill and enough functional exercise are the key points of successful treatment.展开更多
BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation o...BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.展开更多
BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional ou...BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.展开更多
The purpose of this study was to observe the clinical efficacy of umbilical cord in the treatment of Jinri capsule and analyze its effect on postoperative injury and bone metabolism. Methods 90 cases of SAP tree fract...The purpose of this study was to observe the clinical efficacy of umbilical cord in the treatment of Jinri capsule and analyze its effect on postoperative injury and bone metabolism. Methods 90 cases of SAP tree fracture were randomly divided into two groups according to 1:1. In the control group, 45 patients were treated with MIPO, and 45 patients were treated with Jintian capsule based on MIPO for 6 weeks. Organic volume content (VOC), bone mass number (TB.n), elastic bone stress (ES) and calcium (BFP) were compared according to bone volume ratio (BV/TV) before and 6 weeks after operation. Six months postoperatively, bone protective function (OPG), tartrate phosphatase (TRAP), K collagen (KTH) and shoulder recovery were observed. Results Within 6 weeks after treatment, bone quality indexes such as TV were significantly lower than those in control group (P<0.05), and bone quality indexes such as VOC and TBC were significantly lower than those in control group (P<0.05). Significantly lower than control group (P<0.05). N was significantly higher than that of control group (P<0.05). The osteogenesis rates of BGP and OPG were higher than those of the control group (P<0.05), and the osteogenesis rates of TRAP and CTX were significantly lower than those of the control group (P<0.05). Were compared between the two groups before and 6 weeks after operation. Six months after surgery, the observation group had better function recovery, and the constant Murley score was significantly higher than that of the control group. Conclusion MIPO combined with Jintiange capsule can significantly improve the function recovery effect of shoulder joint, effectively stabilize bone mass index, promote the formation of bone structure, quickly recover bone metabolism function, and finally achieve fracture healing. It is worthy of clinical application.展开更多
Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated f...Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated fractures of展开更多
BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been develo...BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.展开更多
Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (avera...Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (average 31 years) with lower third humeral shaft fractures were treated with unilateral external fixators. There were 9 spiral fractures (type A1), 1 oblique fracture (type A2), 3 transverses fractures (type A3) and 20 comminuted fractures (11 type B1, 9 type B2) according to AO classification. Fifteen cases were treated with open reduction and limited internal fixation and fixation with external fixators, 10 cases treated with open reduction and fixation with external fixators, and 8 cases treated with closed reduction and fixation with external fixators. Nerve exploration was undertaken in 9 cases with preoperative radial nerve injury. External fixators were removed after bone healing. The average follow-up was 18 months with a range from 8 to 24 months. Results: The time of bone healing ranged 11-22 weeks (average 14 weeks). The latest follow-up showed the functions of 9 cases of preoperative radial nerve injury and of 2 cases postoperative radial nerve injury and the function of elbow were recovered to normal. There were only 7 cases of superficial infection at pin hole, which was subsided by using oral antibiotics and pin-hole care with mild disinfectants.Conclusions: Fixation with unilateral external fixators combined with open reduction and limited internal fixation has a good effect in the treatment of lower third humeral shaft fractures.展开更多
Objective： To evaluate the value of ultrasonography in non-isplaced and mini-displaced humeral lateral condyle fractures in children. Methods： Nine children aged 2-9 years with non-displaced or mini-displaced humer...Objective： To evaluate the value of ultrasonography in non-isplaced and mini-displaced humeral lateral condyle fractures in children. Methods： Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography. The fracture line through the joint surface was visualized by ultrasonography in 6 case, in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients＇ or their parents＇refusal. In the remaining 3 children, ultra- sonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted. Results： The average follow-up period was 8 months. The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treat-ment and another child who received percutaneous pinning. The elbow function and fracture healing were good in cases received closed reduction and percutaneous pinning. Among the three cases who refused to receive closed reduction and internal fixation, re-displacement occurred in 1 case and delayed union in 1 case. All three cases receiving conservative treatment had good results both in elbow function and fracture healing. Conclusion： High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved. For these cases, arthrography or magnetic resonance imaging is unnecessary.展开更多
There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a comp...There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously.We report a case of a 48 years old femalewho received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse.CT angiogram showed that there was segmental non-opacification of the brachial artery.There was distal reformation and the thrombosis was decided to be managed conservatively.We believe that the arterial injury was a result ofimproper surgical technique and the segmental block might be due to improper use of plate holding forceps.This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.展开更多
Background: Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties ofanteromedial, a...Background: Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties ofanteromedial, anterolateral, and posterior plating for humeral shaft fractures. Methods: A distal third humeral shaft fracture model was constructed using fourth-generation sawbones (#3404, composite bone). A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups: A, B, and C (n = 8 in each group) for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior (AP) and mediolateral (ML) directions and horizontal torsional destructive tests. Results: In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C (P 〈 0.05). In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 ram, 0.13 ram, and 0.20 mm. Group B was smaller than Group C (P 〈 0.05). In ML lbur-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 ram, and 0.17 ram. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05. and 16.83 N·m, respectively. Conclusions: Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group. We can suggest that anteromedial plating is a clinically safe and effective way for humeral shaft fractures.展开更多
Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical rela...Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods： We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures （PHFs） with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows： 75 patients in the medial cortical support （MCS） group, 26 patients in the medial multiscrew support （MMSS） group, 29 patients in the medial single screw support （MSSS） group, and 51 patients in the 11o medial support （NMS） group. Clinical and radiographic evaluations included the Constant-Murley score （CM）, visual analogue scale （VAS）, complications, and revision surgeries. The neck-shaft angle （NSA） was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or KruskaI-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher＇s exact test was used for categorical data. Results： The mean postoperative NSAs were 133.46°± 6.01°, 132.39° ± 7.77°. 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found （F = 1.02, P= 0.387）. In the final follow-up, the NSAs were 132.79° ±6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 4.40, P = 0.008）. There were marked differences in the NSA at the final follow-up between the MCS and NMS groups （P = 0.004）. The median （interquartile range [IQR]） NSA losses were 0.0° （0.0-1.0）°, 1.3° （0.0-3.1）°, 1.5° （ 1.0-5.2）°, and 4.0° （ 1.2 -7.1 ）° in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 60.66, P 〈 0.001 ）. There were marked differences in NSA loss between the MCS and the other three groups （MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P 〈 0.001; and MCS vs. NMS, Z = 7.34, P 〈 0.001）. There was also significantly less NSA loss observed in the MMSS group compared to the NMS group （Z = -3.16, P = 0.002）. However, there were no significant differences between the MMSS and MSSS groups （Z = -1.65, P = 0.225） or the MSSS and NMS groups （Z =- 1.21, P = 0.099）. The average CM scores were 81.35 ± 9.79, 78.04± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 18.68, P 〈 0.001）. The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively （ X^2 = 29.25, P 〈 0.001 ）. The median （IQR） VAS scores were 1 （0-2）, l （0 2）,2 （ 1-3）, and 3 （1-5） points in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 27.80, P 〈 0.001）. Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups （for CM scores： MCS vs. MSSS, P 〈 0.001 ; MCS vs. N MS. P 〈 0.001; MMSS vs. MSSS, P= 0.031 and MMSS vs. NMS, P 〈 0.001 and for VAS values： MCS vs. MSSS, Z=3.31, P = 0.001： MCS vs. NMS, Z = 4.64, P 〈 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037： and MMSS vs. NMS, Z=-3.16, P = 0.003）.Conclusions： Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.展开更多
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
文摘BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.
文摘Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.
文摘There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surgery for the left side and conservative treatment for the right side. The patient was a 73-year-old woman who had been diagnosed with PD 10 years prior to presentation. Open reduction internal fixation was conducted for the left proximal humeral fracture. 7 months after the left shoulder fracture, she fell resulting in a right proximal humeral fracture for which she underwent conservative treatment. Although bone union was obtained bilaterally, anterior subluxation occurred in the operated side 9 months postoperative. Screw remove was performed because perforation of the screw was observed in the humeral head and was causing pain. Currently, restriction in range of motion and subluxation may be seen on the side that received conservative treatment, although pain is absent and patient satisfaction is high. On the operated side, there is a marked restriction in range of motion, subluxation, and pain. Our experience revealed that conservative treatment was effective for proximal humeral fractures and that optimal bone union might be obtained even in patients with suboptimal PD control.
基金approved by King Abdullah International Medical Research Center Ethics Committee(approval No.0000074524).
文摘BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.
文摘Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.
基金Supported by Wuhu Municipal Science and Technology Bureau of Anhui Province,No.2022cg43.
文摘BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.
文摘Background Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors that have an influence on the complications experienced after proximal humeral fractures fixed by locking plates and compare the results from patients having complications with those having no complications. Methods From September 2004 to September 2007, 92 out of 111 displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate were available for follow-up, with an average time of 15.2 months （12-36 months）. The range of motion, Visual Analog Score （VAS） for pain, American Shoulder and Elbow Surgeons＇ Form （ASES）, Constant-Murley, University of California-Los Angles scoring system （UCLA） score, and Simple Shoulder Test （SST） for function evaluation was all recorded at the latest follow-up. The results from patients with complications were evaluated according to the indices listed above and compared with those patients without any complications. Results There were 17 patients with complications, an 18.5% complication rate. Among them, the forward flexion, external rotation and internal rotation were 139.1°±24.3°, 24.1°±19.6°, and up to T10 level on average. The mean VAS score was 1.0±1.1, the ASES score was 82.9±13.8, the Constant 82.1±11.8, the UCLA 28.5±4.1 and the mean SST 9.5 on average. There was no significant difference of complication rate among different age, sex, and injured side, fresh or delayed fracture, combined with other injury or not groups. Compared with the group without complications, patients with complications showed significantly less external rotation and lower Constant-Murley and UCLA functional scores （P 〈0.05）. A significant difference in results was seen between patients with complications and those without complications. Conclusion The indication control and appropriate surgical technique were important while performing the locking plate fixation for proximal humeral fractures.
基金This work was partially supported by Shanghai Municipal Health Bureau(No.2011239)the National Science and Technology Supporting Program of China(No.2012BAI17B02).
文摘The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures.From January 2012 to December 2015,80 cases of senile patients with osteoporotic proximal humeral fractures were randomly divided into an observation group and a control group,each group with a total of 40 cases.The control group was simply treated with locking plate.The observation group was treated with locking plate in combination with biomimetic mineralized collagen putty.The therapeutic effect thereby was observed.The excellent and satisfactory rate was 90%in observation group and was 72.5%in control group.The difference between the two groups was statistically significant(χ^(2)=5.3312,P<0.05).The fracture healing time was 11.8263.62 weeks in observation group and 19.7865.46 weeks in control group.The shoulder joint function score was 89.6368.12 in observation group and 76.9268.18 in control group.There was significant difference between the two groups(t=7.1272;12.7834,P<0.05).The complication rate was 10%in the observation group and 32.5%in the control group(χ^(2)=7.3786,P<0.05).Locking system strengthened by biomimetic mineralized collagen putty has advantages such as accelerating healing of senile proximal humeral fracture,improving the therapeutic effect,reducing the complications.As one of the optimal internal fixation method,it provides a new option for better treatment of senile osteoporotic fracture.
文摘Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total of 55 patients who suffered from com-plex proximal humeral fractures were treated by shoulder hemiarthroplasty. The mean age was 55.6 years and mean follow-up period was 25.1 months. The scoring system modi-fication for hemiarthroplasty (SSMH) had been adopted for evaluation at the latest follow-up.Results: The pain was obviously relieved in all patients. Fifty patients were painless and 5 patients had slight pain. The mean range of motion was 100°(90°-110°) in abduction, 95°(80°-100°) in forward flexion, 35°(30°-40°) in extemal rotation and internal rotation was confined at L2 level (L1-L3). The mean SSMH score was 27.9 (24-29). Fifty patients (90.1%) were satisfied with the clinical outcome.Conclusions: Shoulder hemiarthroplasty is an effective method to treat complex proximal humeral fractures. The proper selection of patients and prosthesis, good operation skill and enough functional exercise are the key points of successful treatment.
文摘BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.
基金Supported by Natural Science Foundation of Chongqing,China,No.CSTB2023NSCQ-MSX1080.
文摘BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
文摘The purpose of this study was to observe the clinical efficacy of umbilical cord in the treatment of Jinri capsule and analyze its effect on postoperative injury and bone metabolism. Methods 90 cases of SAP tree fracture were randomly divided into two groups according to 1:1. In the control group, 45 patients were treated with MIPO, and 45 patients were treated with Jintian capsule based on MIPO for 6 weeks. Organic volume content (VOC), bone mass number (TB.n), elastic bone stress (ES) and calcium (BFP) were compared according to bone volume ratio (BV/TV) before and 6 weeks after operation. Six months postoperatively, bone protective function (OPG), tartrate phosphatase (TRAP), K collagen (KTH) and shoulder recovery were observed. Results Within 6 weeks after treatment, bone quality indexes such as TV were significantly lower than those in control group (P<0.05), and bone quality indexes such as VOC and TBC were significantly lower than those in control group (P<0.05). Significantly lower than control group (P<0.05). N was significantly higher than that of control group (P<0.05). The osteogenesis rates of BGP and OPG were higher than those of the control group (P<0.05), and the osteogenesis rates of TRAP and CTX were significantly lower than those of the control group (P<0.05). Were compared between the two groups before and 6 weeks after operation. Six months after surgery, the observation group had better function recovery, and the constant Murley score was significantly higher than that of the control group. Conclusion MIPO combined with Jintiange capsule can significantly improve the function recovery effect of shoulder joint, effectively stabilize bone mass index, promote the formation of bone structure, quickly recover bone metabolism function, and finally achieve fracture healing. It is worthy of clinical application.
文摘Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated fractures of
文摘BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
文摘Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (average 31 years) with lower third humeral shaft fractures were treated with unilateral external fixators. There were 9 spiral fractures (type A1), 1 oblique fracture (type A2), 3 transverses fractures (type A3) and 20 comminuted fractures (11 type B1, 9 type B2) according to AO classification. Fifteen cases were treated with open reduction and limited internal fixation and fixation with external fixators, 10 cases treated with open reduction and fixation with external fixators, and 8 cases treated with closed reduction and fixation with external fixators. Nerve exploration was undertaken in 9 cases with preoperative radial nerve injury. External fixators were removed after bone healing. The average follow-up was 18 months with a range from 8 to 24 months. Results: The time of bone healing ranged 11-22 weeks (average 14 weeks). The latest follow-up showed the functions of 9 cases of preoperative radial nerve injury and of 2 cases postoperative radial nerve injury and the function of elbow were recovered to normal. There were only 7 cases of superficial infection at pin hole, which was subsided by using oral antibiotics and pin-hole care with mild disinfectants.Conclusions: Fixation with unilateral external fixators combined with open reduction and limited internal fixation has a good effect in the treatment of lower third humeral shaft fractures.
文摘Objective： To evaluate the value of ultrasonography in non-isplaced and mini-displaced humeral lateral condyle fractures in children. Methods： Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography. The fracture line through the joint surface was visualized by ultrasonography in 6 case, in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients＇ or their parents＇refusal. In the remaining 3 children, ultra- sonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted. Results： The average follow-up period was 8 months. The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treat-ment and another child who received percutaneous pinning. The elbow function and fracture healing were good in cases received closed reduction and percutaneous pinning. Among the three cases who refused to receive closed reduction and internal fixation, re-displacement occurred in 1 case and delayed union in 1 case. All three cases receiving conservative treatment had good results both in elbow function and fracture healing. Conclusion： High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved. For these cases, arthrography or magnetic resonance imaging is unnecessary.
文摘There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously.We report a case of a 48 years old femalewho received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse.CT angiogram showed that there was segmental non-opacification of the brachial artery.There was distal reformation and the thrombosis was decided to be managed conservatively.We believe that the arterial injury was a result ofimproper surgical technique and the segmental block might be due to improper use of plate holding forceps.This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.
文摘Background: Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties ofanteromedial, anterolateral, and posterior plating for humeral shaft fractures. Methods: A distal third humeral shaft fracture model was constructed using fourth-generation sawbones (#3404, composite bone). A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups: A, B, and C (n = 8 in each group) for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior (AP) and mediolateral (ML) directions and horizontal torsional destructive tests. Results: In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C (P 〈 0.05). In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 ram, 0.13 ram, and 0.20 mm. Group B was smaller than Group C (P 〈 0.05). In ML lbur-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 ram, and 0.17 ram. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05. and 16.83 N·m, respectively. Conclusions: Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group. We can suggest that anteromedial plating is a clinically safe and effective way for humeral shaft fractures.
文摘Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods： We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures （PHFs） with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows： 75 patients in the medial cortical support （MCS） group, 26 patients in the medial multiscrew support （MMSS） group, 29 patients in the medial single screw support （MSSS） group, and 51 patients in the 11o medial support （NMS） group. Clinical and radiographic evaluations included the Constant-Murley score （CM）, visual analogue scale （VAS）, complications, and revision surgeries. The neck-shaft angle （NSA） was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or KruskaI-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher＇s exact test was used for categorical data. Results： The mean postoperative NSAs were 133.46°± 6.01°, 132.39° ± 7.77°. 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found （F = 1.02, P= 0.387）. In the final follow-up, the NSAs were 132.79° ±6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 4.40, P = 0.008）. There were marked differences in the NSA at the final follow-up between the MCS and NMS groups （P = 0.004）. The median （interquartile range [IQR]） NSA losses were 0.0° （0.0-1.0）°, 1.3° （0.0-3.1）°, 1.5° （ 1.0-5.2）°, and 4.0° （ 1.2 -7.1 ）° in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 60.66, P 〈 0.001 ）. There were marked differences in NSA loss between the MCS and the other three groups （MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P 〈 0.001; and MCS vs. NMS, Z = 7.34, P 〈 0.001）. There was also significantly less NSA loss observed in the MMSS group compared to the NMS group （Z = -3.16, P = 0.002）. However, there were no significant differences between the MMSS and MSSS groups （Z = -1.65, P = 0.225） or the MSSS and NMS groups （Z =- 1.21, P = 0.099）. The average CM scores were 81.35 ± 9.79, 78.04± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 18.68, P 〈 0.001）. The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively （ X^2 = 29.25, P 〈 0.001 ）. The median （IQR） VAS scores were 1 （0-2）, l （0 2）,2 （ 1-3）, and 3 （1-5） points in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 27.80, P 〈 0.001）. Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups （for CM scores： MCS vs. MSSS, P 〈 0.001 ; MCS vs. N MS. P 〈 0.001; MMSS vs. MSSS, P= 0.031 and MMSS vs. NMS, P 〈 0.001 and for VAS values： MCS vs. MSSS, Z=3.31, P = 0.001： MCS vs. NMS, Z = 4.64, P 〈 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037： and MMSS vs. NMS, Z=-3.16, P = 0.003）.Conclusions： Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.
