Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures

Matsunaga, Fábio Teruo; Tamaoki, Marcel Jun Sugawara; Matsumoto, Marcelo Hide; Netto, Nicola Archetti; Faloppa, Flávio; Belloti, João Carlos

doi:10.2106/jbjs.16.00628

Cited by 103 publications

(140 citation statements)

References 30 publications

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“…At the 1-year follow-up visit, all fractures were healed and none of the patients had suffered non-union, an outcome better than that reported for other treatment methods [ 1 , 2 , 5 , 9 , 21 – 23 ]. The mean union times of the Synbone group and the 3D-printed groups were 16.16 and 15.57 weeks, respectively, which was similar to other studies even though our patients were older than in other studies [ 11 , 17 , 24 ].…”

Section: Discussionmentioning

confidence: 64%

“…The optimal treatment for humeral shaft fracture remains controversial. Although a large proportion of these fractures can be treated without surgery, a recent study, involving a randomized controlled trial, compared bridge plate with functional brace fixation for humeral shaft fractures and concluded that surgical plating has a statistically significant advantage with a better DASH score, lower non-union rate, and lower residual deformity rate [ 1 ]. As for proximal third humeral shaft fractures, they were thought to be complicated with a higher non-union rate when treated conservatively compared with middle and distal fractures [ 2 , 5 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Humeral shaft fractures account for approximately 3% of all bone fractures [ 1 – 4 ], and for most of these, non-operative treatment with a functional brace is recommended. However, the non-union rate of fractures in the proximal third of the humerus is relatively higher than for those in other regions with conservative treatment, and shoulder stiffness problems tend to appear after long-term external fixation [ 2 , 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model—a retrospective study

Wang

Guan

et al. 2018

J Orthop Surg Res

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BackgroundTo explore the clinical efficacy of 3D printing fracture models to assist in creating pre-contoured plates to treat proximal third humeral shaft fractures.MethodsWe retrospectively identified proximal third humeral shaft fractures treated between February 2012 and February 2015. The patients were divided into two groups according to the treatment procedure: a Synbone group and a 3D-printed group. In the Synbone group, long proximal humeral internal locking system plates were pre-contoured into helical shape on Synbones before surgery, while in the 3D-printed group, they were contoured on 3D-printed bone models. The pre-contoured plates were sterilized before surgery and were then used for fracture fixation during surgery. Duration of surgeries, blood loss volumes, the incidence of complications, and the time to fracture union were recorded, and functional outcomes were assessed by the Constant-Murley shoulder score and the Mayo Elbow Performance Score (MEPS) at 1-year follow-up.ResultsThe subjects comprised 46 patients; 25 patients were allocated to the Synbone group and the remaining 21 to the 3D-printed group. There was no significant difference between the baseline characteristics of the two groups. At the 1-year follow-up visit, all fractures were healed and showed a satisfactory outcome. There were no instances of iatrogenic radial nerve injury, and there was no significant difference between the two groups with regard to fracture union time, Constant-Murley score, or MEPS score. Surgery duration was significantly shorter in the 3D-printed group compared to the Synbone group (42.62 vs. 60.36 min, P = 0.001), and the 3D-printed group lost less blood during surgery (105.19 vs. 120.80 ml, P = 0.001). In addition, in the 3D-printed group, 9 surgeries were finished by senior attending doctors and 12 were finished by junior attending doctors; however, there was no significant difference between the 1-year outcomes of the two grades of surgeons.ConclusionsOur results show that the 3D printing technique is helpful in shortening the duration of surgery, reducing blood loss volume, and in making this surgical procedure easier for less-experienced surgeons.Trial registrationThis clinical study was registered in CHICTR on September 30, 2017 (number 17012852).

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model—a retrospective study

Wang

Guan

et al. 2018

J Orthop Surg Res

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“…However, these angular deformities are generally well tolerated with minimal functional impairment [1, 2, 11 -13]. Matsunaga et al, compared surgical fixation and functional bracing and found patients who were fixed had higher DASH scores, higher rates of union, and less anteroposterior residual angulation [14]. However, there were no differences with regards to the SF-36 score, pain level, and Constant score.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Outcome of a New Functional Brace for the Management of Humeral Shaft Fractures

Athreya¹,

Abbott²,

Elias³

et al. 2019

TOORTHJ

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Background: Our practice identified several issues with the commercially available plastic off-the-shelf Sarmiento brace that is used in managing humeral shaft fractures, with regards to comfort, moulding, and ability to hold reduction. A custom-moulded fibreglass brace was developed which was soft padded for comfort, lightweight, and could be adjusted with changes in swelling. Objective: The aim of this study was to evaluate the use of this new brace. Methods: 16 patients were identified having treatment with the brace from March 2011 to July 2013. Retrospective analysis of medical records and imaging occurred to assess union and angulation. Prospective analysis of patient function was assessed with the CONSTANT, DASH and SPADI Shoulder score. Results: Patients were initially managed with a U-Slab for an average of 26 days. Patients were followed up for an average of 70 days post brace application. 5 patients were lost to follow up. The remaining 11 patients had the brace on for an average of 73 days. In the last follow up, 15 patients had an acceptable anterior/posterior angulation of less than 200 (1 patient - 220), varus/valgus angulation less than 200, and less than 3cm of shortening. 12 patients had radiological evidence of union, with the other 4 demonstrating significant callus. 4 patients were recruited for prospective analysis with DASH, SPADI and CONSTANT shoulder scores, and demonstrated minimal loss of function. There were no complications of bracing treatment. Conclusion: Our new functional brace led to bony union in most patients, and from a clinical perspective, most patients were pain free and had minimal loss of function.

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“…Die Inzidenz von Pseudarthrosen beträgt im proximalen Schaftdrittel 24 %, im mittleren Drittel 12 % und im distalen Schaftdrittel 15 % [5]. Obgleich manche Studien bei frischen Schaftfrakturen eine ähnliche Ausheilungsrate und Ausheilungszeit für konservativ behandelte PatientInnen im Vergleich zu operativ versorgten PatientInnen angeben, gibt es doch eine gewisse Evidenz, dass die Osteosynthese (Plattenosteosynthese) zu einer deutlich geringeren Rate an Fehlverheilungen und Pseudarthrosen führt [6,7]. Auch im eigenen Krankengut können die hohen Ausheilungsraten, die von Sarmiento et al [1] angegeben wurden, mit der Brace-Behandlung nicht erreicht werden.…”

Section: Humerusschaftunclassified

Pseudarthrosen und schlecht heilende Frakturen am Humerusschaft und am distalen Humerus

Plecko¹

2019

OP-JOURNAL

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ZusammenfassungFrakturen am Humerusschaft werden häufig konservativ im Brace behandelt und werden allgemein als benigne Frakturen mit hoher Heilungspotenz eingestuft. Dennoch kommt es, je nach Abschnitt, in 12 – 24% zur Ausbildung einer Pseudarthrose. Meist ist die Funktionalität des Armes so gestört, dass eine operative Behandlung notwendig wird. Eine exakte Analyse ist für den Erfolg der Therapie unumgänglich. Die Plattenosteosynthese, bevorzugt mit interfragmentärer Kompression und Anlagerung autologer Knochenspäne, führt in der überwiegenden Mehrzahl der Fälle zu einer raschen und soliden Heilung und ermöglich gleichzeitig die Korrektur relevanter Fehlstellungen. Bei atrophen Pseudarthrosen sind zusätzlich Maßnahmen zur Verbesserung der lokalen Biologie notwendig. Am distalen Humerus ist häufiger die suprakondyläre Region betroffen. Hier steht die Einstauchung und Kompression der Knochenenden gegeneinander sowie die Defektauffüllung mit autologen Knochenspänen im Vordergrund. Eine Doppelplattenosteosynthese sorgt für ausreichende Stabilität. Ein ausgedehntes Kapselrelease verhindert eine erhöhte Belastung der Frakturzone und verhindert eine zu starke postoperative Bewegungseinschränkung. Bei Fällen, die nicht stabil rekonstruierbar sind, stellt die Ellbogentotalendoprothese eine sehr gute Rettungsoperation dar.

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Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 103 publications

References 30 publications

Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model—a retrospective study

Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model—a retrospective study

Evaluating the Outcome of a New Functional Brace for the Management of Humeral Shaft Fractures

Pseudarthrosen und schlecht heilende Frakturen am Humerusschaft und am distalen Humerus

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