Treatment of Midshaft Humerus Fractures Using Early Functional Bracing: Results and Prognostic Factors

Arealis, Georgios; Faria, Giles; Kučera, Milan; Crisan, Cosmin; Murthy, Sathya

doi:10.7759/cureus.14852

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…tvrdili, že meranie defektu na rtg snímkach je nepresné, lebo sa nepočíta s kalibráciou rtg snímok. Preto zaviedli FDI index (fracture displacement index), ktorý eliminuje kalibračnú chybu, a to percentuálnym vyjadrením dislokácie fragmentov (3). Z našich pacientov malo 5 (36%) defekt 0,5mm -1cm, 6 (43%) v rozmedzí 1-3cm a traja (21%) väčší ako 3cm.…”

Section: Diskusiaunclassified

Predictive Factors and Treatment of Aseptic Pseudoarthrosis of the Humeral Shaft

Popelka¹,

Popelka²

2022

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYAseptic pseudoarthrosis (nonunion, PSA) of the humeral shaft is one of the serious complications in the treatment of fractures in this area. In a retrospective study, the authors described different methods of treating patients with this complication using predictive factors. MATERIAL AND METHODSBased on the definition of nonunion and the criteria, 14 patients (N=14) with the mean age of 56 years (32-78), namely 8 men and 6 women were included in the study. All patients were followed up clinically and radiologically at 1, 3, 6, 9, 12 months and every 3 months until the condition stabilized. The follow-up period was 11-72 months, with the average of 22 months. According to the AO classification, the fractures were classified as: 4-A1, 1-A2, 4-A3, 1-B1, 3-B2 and 1-C2. Based on the Weber-Čech classification, 2 cases of pseudoarthrosis were hypertrophic, 4 oligotrophic and 8 atrophic. According to the Non-Union Scoring System (NUSS), 5 patients reached the score under 25 points, 3 patients received 25-50 points, 4 patients 51-75 points and two patients over 76 points. In five cases, the fracture displacement index (FDI) was above 100%. In 11 patients, PSA was in the proximal and middle third and in three patients in the distal third of the humerus. METHODSOf the whole group (N=14), the nail was used in 5 cases (36%) -in 3 cases NUSS of up to 50 points and in 2 cases over 76 points. The plate was used in 9 cases (64%). In patients with NUSS of up to 50 points -in 1 case after conservative treatment, in 1 case for augmentation of nail, in 3 cases for augmentation of Prévot nails. In 4 cases with NUSS of 51-75 points a plate was replaced. Osteosynthesis was always supplemented by Judet's decortication or resection of atrophic bone and spongioplasty by autologous graft. RESULTSShoulder function measured by the Constant Murley score (C-M) improved from 53 to 89 points (from the range of 36-76 points to the range of 75-100 points). The function of the elbow joint also improved, namely from the Mayo Elbow Performance Score (MEPS) of 65 points to 90 points (from the range of 45-70 points to the range of 80-100 points). In 11 cases (79%) the nonunion was healed and in 3 cases (21%) the failure to heal was reported. In the group with unhealed nonunions, in one case with NUSS of 51-75 points a thermoplastic casting was used and in two patients with NUSS above 76 points a palliative surgery was performed using a 12mm interlocking intramedullary nail. DISCUSSIONThe results of our study focused on the treatment of aseptic nonunion of the humeral shaft confirm the conclusions arrived at by other authors. As to the osteosynthesis materials, the plate remains the gold standard and provides sufficient stability for bone healing. For unhealed treatment-resistant PSA, we offer a stable intramedullary nail instead of prosthetic replacement or amputation, which provides good stability required for limb function. CONCLUSIONSWhen planning the treatment of aseptic pseudoarthrosis of the humeral shaft, it is necessary to h...

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Section: Diskusiaunclassified

Predictive Factors and Treatment of Aseptic Pseudoarthrosis of the Humeral Shaft

Popelka¹,

Popelka²

2022

Acta Chir. orthop. Traum. Cech.

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Treatment fracture of the diaphisis humerus with functional plaster

Jovanović¹,

Miljković²,

Petrović³

et al. 2021

Praxis medica

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Treatment of humerus fractures is divided into operative and non-operative treatment Fractures of the diaphysis of the humerus heal well. Surgeons today have many opportunities to treat them. The decision on the type of treatment to be applied depends on the location of the fracture, the existence of associated injuries, the age and the general condition of the patient. Non-operative treatment is most often applied, although there are fractures in which surgical intervention is necessary in order to perform healing and prevent complications. Non-operative treatment of fractures of the diaphysis of the humerus gives good results, with little angulation and minimal or no shortening of the arm. Adequate repositioning, appropriate plaster immobilization and regular X-rays heal the fracture within the allotted time. Disciplined early physical therapy in terms of circular movements prevents shoulder contracture and allows later physical therapy to last significantly shorter. Non-operative treatment lasts from 7-11,5 weeks.

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Treatment of Midshaft Humerus Fractures Using Early Functional Bracing: Results and Prognostic Factors

Cited by 2 publications

References 22 publications

Predictive Factors and Treatment of Aseptic Pseudoarthrosis of the Humeral Shaft

Predictive Factors and Treatment of Aseptic Pseudoarthrosis of the Humeral Shaft

Treatment fracture of the diaphisis humerus with functional plaster

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