Objective To investigate the therapeutic effect of long PHILOS locking compression plate on the proximal humerus and humeral shaft fractures. Methods From March 2005 to December 2007, 35 cases with the proximal humerus and humeral shaft fractures were treated with long PHILOS locking compression plate, including 16 males and 19 females aged 29-68 years old (average 54.5 years old). There were 34 cases of fresh and close fracture, and the time from injury to operation was 3-9 days. One case had delayed union of fracture 5 months after receiving T-plates and internal fixation with steel plate. For the proximal humerus fracture, 7 cases had 2 parts of fracture, 19 had 3 parts of fracture, and 9 had 4 parts of fracture according to Neer classification; while for the humeral shaft fracture, 3 cases were classified as A1, 5 as A2, 10 as B1, 3 as B2, 6 as B3, 7 as C1 and 1 as C3 according to AO classification. Postoperatively, Neer scoring system was employed to evaluate the function of shoulder joint and HSS scoring system was adopted to evaluate the function of elbow joint. Results All incisions healed by first intension, and 30 cases were followed up for 12-33 months (average 18.2 months). Postoperatively, 2 cases had symptoms of radial nerve paralysis, which disappeared within 3 weeks; 1 case suffered from humeral head necrosis and received the secondary operation of humeral head replacement; humeral head was reduced evenly in 1 case, and 2 cases felt chronic sl ight pain in shoulder joints and received no further treatment. X-ray films showed 29 cases had fracture heal ing 6 months after operation, and all the patients had bone union 12 months after operation except 1 case receiving humeral head replacement. No such compl ications as screw lossening and internal fixation loosening occurred. By Neer scoring system, 6 cases were graded as excellent, 19 as good, 3 as fair, 2 as poor, and the excellent and good rate was 83.3%. By HSS scoring system, 16 cases were gradedas excellent, 14 as good, and the excellent and good rate was 100%. Conclusion Applying long PHILOS locking compression plate in the treatment of the proximal humerus and humeral shaft fractures provides a sol id fixation and high satisfactory rate with minor compl ications.
Objective To compare the efficacy of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture. Methods We identified eligible studies in PubMed (1950 to September 2007), MEDLINE (1950 to September 2007), OVID CINAHL (1950 to September 2007), OVID EBM (3rd Quarter 2007), CBMdisk (1978 to June 2007) and CNKI (1981 to June 2007). We also handsearched several Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials (RCTs) comparing plating versus intramedullary nailing for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were conducted with Stata 10.0. Results Six RCTs involving 425 patients were included, among which the statistical heterogeneity was not significant (Pgt;0.1). Cumulative meta-analyses showed that intramedullary nailing might increase the re-operation rate in studies conducted before the year of 2000 (OR=0.39, 95%CI 0.17 to 0.90, P=0.03), but the difference was not significant in studies conducted after 2000 (OR=0.54, 95%CI 0.27 to 1.08, P=0.08). Intramedullary nailing might increase the incidence of shoulder impingement compared with plating (OR=0.13, 95%CI 0.03 to 0.65, P=0.01). The rates of non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure were similar between plating and intramedullary nailing. Meta-analyses were not conducted for union time, operation time and bleeding (transfusion) volume, because the relevant data were not available from the included trials. Conclusion Intramedullary nailing may increase the incidence of shoulder impingement. The rates of re-operation, non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure are similar between plating and intramedullary nailing. Further well-designed and large-scale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.
ObjectiveTo evaluate the effectiveness of minimally invasive osteosynthesis using the helical plate for complex humeral shaft fractures involved proximal metaphysis, and to explore its feasibility and security. MethodsA retrospective analysis was made on the clinical data of 16 patients with complex humeral shaft fractures involved proximal metaphysis who underwent minimally invasive osteosynthesis with the helical plate between December 2009 and May 2015. There were 11 males and 5 females, aged from 18 to 56 years (mean, 34.6 years). The causes of fracture included falling injury in 5 cases, falling injury from height in 3 cases, traffic accident injury in 4 cases, sports injury in 3 cases, and belts twisted injury in 1 case. Accroding to Orthopaedic Trauma Association (OTA) classifications, 6 cases were rated as type 12-C1, 3 cases as type 12-C2, and 7 cases as type 12-C3. The time between injury and operation was 2-13 days (mean, 7.2 days). The operation time, intraoperative blood loss, complications, union time were recorded, the functional outcome of the elbow joint was evaluated by Mayo elbow performance score, and the function of the shoulder was assessed by the University of California at Los Angeles (UCLA) shoulder rating scale. ResultsThe mean operation time was 92 minutes (range, 51-127 minutes), and the mean intraoperative blood loss was 212 mL (range, 100-450 mL). All incisions healed by first intention without neurologic complications or wound infection. All patients were followed up 8-28 months (mean, 16.6 months), and bony union was obtained at 13-36 weeks (mean, 19.2 weeks). No loosening or breakage of internal fixation occurred. The Mayo elbow performance score was 90-100 (mean, 99), and the UCLA shoulder rating scale was 31-35 (mean, 34.6). ConclusionThe technique of minimally invasive osteosynthesis using the helical plate is safe and feasible for humeral shaft fracture, especially for complex humeral shaft fractures involved proximal metaphysis, and it has the advantages of minimal invasion and low risk for iatrogenic nerve injury and satisfactory effectiveness.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.
Objective To assess the effectiveness of locking compress plate and extra cortical bone bridge fixation for treating atrophic humeral nonunion. Methods Seventeen patients with atrophic humeral nonuninon were treated with locking compress plate and extra cortical bone bridge fixation between November 2006 and June 2015. Of 17 cases, 11 were male, 6 were female, aged 24-63 years (mean, 38.2 years). Fracture located at the left side in 9 cases and at the right side in 8 cases. The mechanism of injury was traffic accident in 13 cases, falling from height in 3 cases, and heavy pound injury in 1 case. The patients underwent surgery for 1 time in 7 cases, for 2 times in 5 cases, for 3 times in 4 cases, and for 4 times in 1 case. The time from fracture to hospitalization was 10-76 months (mean, 22.6 months). The shoulder function was evaluated by Neer score, and elbow function by Mayo score. Results All incisions healed by first intention. Two cases had transient radial nerve symptoms of numbness. All patients were followed up 27.3 months on average (range, 15-60 months). Radiographic examination showed signs of bone remodeling at 6-8 weeks after operation, and formation of extra cortical bone bridge. All of them achieved bone union within 10 to 41 weeks (mean, 17.6 weeks). At last follow-up, the average Neer score was 83.36 (range, 72-96); and the shoulder function was excellent in 10 cases, good in 5, and fair in 2 with an excellent and good rate of 88.24%. And the average Mayo score was 86.52 (range, 68-100); and the elbow function was excellent in 11 cases, good in 3, and fair in 3 with an excellent and good rate of 82.35%. Conclusion The bone bridging could effectively form by extra cortical grafting technique. Atrophic humeral nonunions can be successfully treated with locking compress plate and extra cortical bone bridge fixation.
Objective To study the effect of anterior plate fixation on the treatment of middle and lower thirds fractures of humerus and the possibility of operating without injuring the radial nerve. Methods Forty-nine patients with the middle and lower thirds fractures of the humerus were treated with anterior plate fixation from March 1998 to December 2002. Of the 49 patients, 27 were with new fractures, 12 with old fractures, and 10 with nonunion fractures. According to AO classification, of the 49 patients, there were 19 type A, 14 type B1, 9 type B2, 5 type B3, 2 type C1. Thirty-seven patients had closed fractures and 12 had open fractures. Of the 12 patients, 8 were type Gustilo Ⅰ, 4 were type Gustilo Ⅱ. Four out of the 49 patients were associated with radial nerve palsy. All patients were treatedwith anterior plate fixation through the anterior approach to the humerus. The radial nerves injured were explored. Results Of the 49 patients, 48 were followed up 6 to 48 months(28.7 months on average). All fractures were healed within 3 to 9 months(4.7 months on average). Fixed plates of 37 patients out of the 49 were removed. No iatrogenic radial nerve injury occurred in the82 times of the operations among the 49 patients. Conclusion The treatment of middle and lower thirds fractures of humerus by anterior platefixation through the anterior approach to the humerus does not interfere with the fracture healing and can prevent the iatrogenic radial nerve injury.
Objective To investigate an effect of the minimally-invasive locking compression plate (LCP) under the anterior humeral approach to treat the complex humeral shaft fracture. MethodsEleven patients (6 males, 5 females; age, 3266 years) with a humeral shaft fracture were treated with the minimally-invasive LCP under the modified anterior humeral approach from March 2005 to February 2006. Five of the patients were injured in a traffic accident and the remaining 6 were wounded in a fall. All the patients had an unstable fracture. The multiple segment fracture was found in 2 patients, the obligue line fracture in 1 patient, and the long segment comminuted fracture in 8 patients, of whom the radial nerve injury was found in 1 patient, who had an emergency treatment by the loosening of the radial nerve and the internally fixing with LCP. As for the fracture site, the middle and/or the upper-part fracture of the humerus was found in6 patients, and the middle and/or lower-part fracture of the humerus was foundin 5 patients. The patients underwent the operation in the period from 48 hours to 4 days after the injuries. Results All the patients had a complete healing of their fractures 2-4 months after operation. One patient underwent the loosening of the radial nerve and the internally-fixing with LCP, and his function recovered 3 days after operation.The follow-up for 6-12 months revealed that all the patients’ function recovered. According to the Neer Scoring System for the shoulder function evaluation, 7 patients had an excellent result, 3 had a good result, and 1 had a fair result. According to the HSS Scoring System, 9 patients had an excellent result and 2 had a good result. Conclusion The minimally-invasive locking compression plate under the anterior humeral approach to treat the complex humeral shaft fracture is an effective and safe method of treating the complex humeral shaft fracture.