Introduction The humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage. Methods In this retrospective study, 109 patients were evaluated, who, during a period of 6 years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS. Results and conclusion The healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.

Background Impact of concomitant fractures on patients sustaining a proximal femur fracture remains unclear. Rising numbers and patient need for rehab is an important issue. The objective of our study was to investigate the impact of concomitant fractures, including all types of fractures, when treated operatively, for proximal femur fractures on the length of hospital stay, in-house mortality and complication rate. Methods Observational retrospective cohort single-center study including 85 of 1933 patients (4.4%) with a mean age of 80.5 years, who were operatively treated for a proximal femoral and a concomitant fracture between January 2016 and June 2020. A matched pair analysis based on age, sex, fracture type and anticoagulants was performed. Patient data, length of hospital stay, complications and mortality were evaluated. Results The most common fractures were osteoporosis-associated fractures of the distal forearm (n = 34) and the proximal humerus (n = 36). The group of concomitant fractures showed a higher CCI than the control group (5.87 vs. 5.7 points; p < 0.67). Patients with a concurrent fracture had a longer hospital stay than patients with an isolated hip fracture (15.68 vs. 13.72 days; p < 0.056). Complications occurred more often in the group treated only for the hip fracture (11.8%, N = 20), whilst only 7.1% of complications were recorded for concomitant fractures (p < 0.084). The in-house mortality rate was 2.4% and there was no difference between patients with or without a concomitant fracture. Conclusions A concomitant fracture to a hip fracture increases the length of hospital stay significantly but does not increase the complication rate or the in-house mortality. This might be due to the early mobilization, which is possible after early operative treatment of both fractures.

No abstract

Introduction In spiral fractures of the tibia, the stability of an osteosynthesis may be significantly increased by additive cerclages and, according to biomechanical studies, be brought into a state that allows immediate full weight bearing. As early as 1933, Goetze described a minimally invasive technique for classic steel cerclages. This technique was modified, so that it can be used for modern cable cerclages in a soft part saving way. Method After closed reduction, an 8 Fr redon drain is first inserted in a minimally invasive manner, strictly along the bone and placed around the tibia via 1 cm incisions on the anterolateral and dorsomedial tibial edges using a curette and a tissue protection sleeve. Via this drain, a 1.7 mm cable cerclage can be inserted. The fracture is then anatomically reduced while simultaneously tightening the cerclage. Subsequently, a nail or a minimally invasive plate osteosynthesis is executed using the standard technique. Using the hospital documentation system, data of patients that were treated with additional cerclages for tibial fractures between 01/01/2014 and 06/30/2020 were subjected to a retrospective analysis for postoperative complications (wound-healing problems, infections and neurovascular injury). Inclusion criteria were: operatively treated tibial fractures, at least one minimally invasive additive cerclage, and age of 18 years or older. Exclusion criteria were: periprosthetic or pathological fractures and the primary need of reconstructive plastic surgery. SPSS was used for statistical analysis. Results 96 tibial shaft spiral fractures were treated with a total of 113 additive cerclages. The foregoing resulted in 10 (10.4%) postoperative wound infections, 7 of which did not involve the cerclage. One lesion of the profundal peroneal nerve was detected, which largely declined after cerclage removal. In 3 cases, local irritation from the cerclage occurred and required removal of material. Conclusion In the described technique, cerclages may be inserted additively at the tibia in a minimally invasive manner and with a few complications, thus significantly increasing the stability of an osteosynthesis. How this ultimately affects fracture healing is the subject of an ongoing study.

Zusammenfassung Einleitung Die Therapie der Humerusschaftfraktur ist vielfältig und oft problematisch. Neben der konservativen Therapie konkurrieren Marknagel- und Plattenosteosynthese miteinander; bislang existiert kein Goldstandard. Aus biomechanischen Überlegungen bieten sich für die Versorgung von Spiralfrakturen additive Cerclagen an. Die Argumente gegen deren Verwendung sind zum einen die Gefahr von Radialisläsionen, zum anderen eine mutmaßliche Störung der Fragmentdurchblutung. Ziel dieser  Studie ist die Analyse sekundärer Radialisläsionen bei der Anwendung additiver, limitiert invasiver Cerclagen bei der antegraden Nagelosteosynthese von Humerusschaftfrakturen. Methodik In dieser retrospektiven Studie erfolgen die klinische und die neurologische Untersuchung von 102 Patienten, welche im Zeitraum von 5 Jahren bei einer Humerusschaftfraktur operativ versorgt wurden. Insgesamt wurden zur Marknagelosteosynthese 193 Cerclagen durch einen limitiert invasiven Zugang eingebracht. Ergebnisse und Schlussfolgerung Bei 4 Patienten (3,9 %) zeigte sich eine sekundäre Radialisläsion im Rahmen der operativen Stabilisierung. Die neurophysiologische und neurosonographische Untersuchung zeigten in keinem Fall eine Kompromittierung des Nerven durch Einschlingen oder gar Durchtrennung durch die additive Cerclage. Zwei Nervenläsionen erholten sich innerhalb von 3 bzw. 6 Monaten spontan. In den anderen 2 Fällen konnte der Verlauf aufgrund eines Exitus letalis nicht über 12 Monate dokumentiert werden. Mit 3,9 % der iatrogenen Radialisläsionen liegt die Rate an Nervenläsionen im unteren Bereich dessen, was in der Literatur für die operative Therapie von Humerusschaftfrakturen beschrieben wird (3–12 %). Durch die limitiert invasive, additive Cerclage ergibt sich somit kein erhöhtes Risiko für die iatrogene Schädigung des N. radialis.

No abstract