Nonoperative treatment of humeral shaft fractures revisited

Ali, Erden; Griffiths, David; Obi, Nnamdi; Tytherleigh-Strong, Graham; Rensburg, Lee Van

doi:10.1016/j.jse.2014.05.009

Cited by 101 publications

(96 citation statements)

References 13 publications

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“…This approach combines the advantages of non-operative management with the benefits of early functional treatment. Surgical treatment is reserved for exposed fractures, in cases of neurovascular injury, in obese patients in polytrauma, in patients with extension of the fracture into the joints, and conservative treatment fails [20,21]. Often, patients request the possibility of early mobilization and without restrictions, which is why there has been an increase in the use of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The plate osteosynthesis allows anatomical reduction of the fracture, the direct viewing, interfragmentary compression of the fracture and the chance to explore and isolate the radial nerve [21]. Nowadays, various studies consider it superior to intramedullary nailing and it remains the preferred technique in the fractures of the humeral shaft [26-28].…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, various studies consider it superior to intramedullary nailing and it remains the preferred technique in the fractures of the humeral shaft [26-28]. However, this technique has the disadvantage of extensive surgical dissections, as well as soft tissue and the radial nerve damage [21]. Moreover, the presence of unsightly scars and the opening of the central point of fracture with the loss of the hematoma fracture, represent other disadvantages of this technique [29].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Plate, Nail and External Fixation in the Management of Diaphyseal Fractures of the Humerus

et al. 2017

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Introduction:Humeral shaft fractures are quite common in orthopedics and represent 1-3% of adult fractures. The surgical treatment is the a better choice in order to obtain a reduction and stable alignment and to prevent the complications. The goal of this study was to compare the three techniques (IMN, LCP and EF) in the treatment of diaphyseal fractures of the humerus in the adult patient.Materials and Methods:We examined 79 patients with diaphyseal fractures of the humerus. 32 were treated with plaque (LCP), 26 with intramedullary nail (IMN) and 21 with eternal fixer (FE) The clinical and radiographic follow-up was done at 1.3, 6 and 12 months. As rating scales we used the ASES and SF-36. We recorded all the complications.Results:The median follow-up was 11.5 months (9-16). The operative time was significantly smaller in the case of FE (47 ‘) with a statistically significant difference compared with other techniques. Even the blood loss was lower in the case of FE (60ml), compared to nails (160ml) and LCP (330ml) p <0.05. We had no differences in the duration of hospitalization and the ASES SF-36 score. We had 2 cases of non-union in the LCP group, 1 case in the IMN group and no cases in the FE group. In IMN group we had one case of radial transient paralysis. We did not have any deep infection, in the FE group 8 patients we had superficial secretions from pins.Conclusion:From the results of our study, it is clear that the treatment of humeral shaft fractures guarantee overlapping results with the use of plates, of intramedullary nails, or with the external fixator. Consequently, the choice of which technique to use should be determined based on the experience of the operator and patient compliance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of Plate, Nail and External Fixation in the Management of Diaphyseal Fractures of the Humerus

et al. 2017

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“…But currently, patient demands for greater comfort provided by unrestricted and early mobilisation without casting, meant that this treatment option attracted a lot of interest [15]. Moreover, there are studies reporting disadvantages of non-operative treatment with higher rates of nonunion in certain fracture patterns and loss of reduction compared to operative management [16]. Sarmiento et al reported that malunion in a varus position occurred in 13 % of the patients and malunion with an apex-anterior angulation occurred in 19 % of the patients [4].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series

Metsemakers

Wijnen

Sermon³

et al. 2015

Arch Orthop Trauma Surg

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“…Distal third fractures demonstrated an 85% union rate, and midshaft fractures revealed the highest union rate at 88%. 8 Other factors that have been shown to predispose patients to delayed or nonunion of isolated fractures include highly comminuted shaft fractures (any location), proximal third, and 2-part/short spiral–oblique, and transverse fracture patterns 4–7 (Fig. 1A).…”

Section: Introductionmentioning

confidence: 99%

Controlled Compression Nailing for At Risk Humeral Shaft Fractures

Watson

Sanders²

2017

Journal of Orthopaedic Trauma

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Summary:Compression techniques seem to be the primary factor in determining the success of both plating and nailing techniques for the management of acute fractures and for delayed and nonunion management of these fractures. An intramedullary nail that can provide continual compression (like a plate) and mechanical manipulation of the callous throughout the course of treatment is an ideal device that provides all the advantages of plating and nailing and avoids the noted limitations of both. The UNYTE compression humeral nail is based on the PRECICE intramedullary limb lengthening system. This nail provides the ability to intraoperatively compress a humeral fracture immediately and continue compression in the outpatient setting with the external remote controller. This compression nail allows the surgeon to continually modulate stability through controlled compression and the ability to relengthen if necessary. The capacity to achieve constant compression at the fracture site has demonstrated rapid healing of the “at risk” humerus fracture in this series. We review the current indications for use of this device after its early introduction. In most cases, this was the failure of conservative brace management that presented with a progressive distraction gap and minimal callous formation or those fractures that could not be adequately controlled in the brace with malalignment greater than 20 degrees. The protocol for intraoperative compression using the external remote controller is detailed, as is the outpatient protocol for follow-up. The compression algorithm for progression to full fracture healing is also reviewed.

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Nonoperative treatment of humeral shaft fractures revisited

Cited by 101 publications

References 13 publications

Comparison of Plate, Nail and External Fixation in the Management of Diaphyseal Fractures of the Humerus

Comparison of Plate, Nail and External Fixation in the Management of Diaphyseal Fractures of the Humerus

Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series

Controlled Compression Nailing for At Risk Humeral Shaft Fractures

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