This study included 15 patients with humeral shaft fractures who had no clinical, radiological or bone scan signs of healing after eight months. The patients were followed for a mean of 35.8 months. No patient was lost to follow-up. Anterior plating of humeral shaft nonunion via an anterior approach was performed using a straight plate and compression for well-vascularised non-unions and wave plating with a tricortical graft for poorly vascularised non-unions. All non-unions healed within 6-18 weeks (mean, nine weeks) without local complication. One patient had a mild decrease in elbow and shoulder range of motion. No neurovascular injury was observed. Anterior plating is a simple, safe and effective treatment for humeral shaft nonunion. As this approach avoids the need for radial nerve visualisation and extensive soft-tissue dissection, and the healing time is similar to that of other methods, we suggest this treatment as an alternative option.
No detailed descriptions exist of the collateral intercostal artery which can provide an accurate anatomical basis for ensuring a low rate of vascular complications during thoracocentesis and thoracoscopy. Consequently the present study was undertaken to provide information on the origin, size and topographic relationships of the collateral intercostal artery. Ninety cadaveric adult intercostal spaces were dissected using standard procedures. The collateral intercostal arteries were exposed throughout their full length and measured at the points within the intercostal spaces considered to be the most important for clinical purposes. The posterior intercostal arteries and their collateral branches were observed to decrease in size from posterior to anterior; however, no significant differences were present in their size in the first four intercostal spaces. Based on these findings the usual thoracocentesis or thoracoscopy technique, in which it is recommended that puncture is done as close as possible to the superior margin of the inferior rib, may lead to collateral intercostal artery laceration and considerable bleeding. A subtle, but important, modification to this technique is suggested aimed at achieving safer access to the intercostal space. In the modified technique, the puncture should be made in the middle of the intercostal space, thereby reducing the possibility of laceration of the collateral intercostal artery.
OBJECTIVES: To evaluate the outcomes in patients treated for humerus distal third fractures with MIPO technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery. METHODS: The patients were treated with MIPO technique. The visualization and isolation of the radial nerve was done by an approach between the brachialis and the brachiorradialis, with an oblique incision, in the lateral side of the arm. MEPS was used to evaluate the elbow function. RESULTS: Seven patients were evaluated with a mean age of 29.8 years old. The average follow up was 29.85 months. The radial neuropraxis after surgery occurred in three patients. The sensorial recovery occurred after 3.16 months on average and also of the motor function, after 5.33 months on average, in all patients. We achieved fracture consolidation in all patients (M=4.22 months). The averages for flexion-extension and prono-supination were 112.85° and 145°, respectively. The MEPS average score was 86.42. There was no case of infection. CONCLUSION: This approach allowed excluding a radial nerve interposition on site of the fracture and/or under the plate, showing a high level of consolidation of the fracture and a good evolution of the range of movement of the elbow. Level of Evidence IV, Case Series
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