Search Results (28)

Background: Humeral shaft fractures (HSFs) represent 13–25% of humeral fractures and are frequently complicated by radial nerve palsy and nonunion. While conservative management was historically preferred, surgical fixation with intramedullary nailing (IMN) has gained increasing popularity. The aim of this study was to evaluate the effectiveness of IMN in the treatment of HSFs, focusing on postoperative complications and functional outcomes. Methods: A bicenter retrospective analysis was conducted on 202 patients who underwent antegrade IMN fixation for HSF between 2014 and 2019, with a minimum follow-up of four years. Demographic data, trauma characteristics, surgical details, and postoperative complications were recorded. Functional outcomes were assessed at one year using the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), and Visual Analogue Scale (VAS). Statistical analysis included ANOVA, Student’s t-test, Spearman’s correlation, and multivariate regression. Results: The mean follow-up was 57.7 ± 19.6 months. At one year, mean OSS, DASH, CSS, and VAS scores were 39.0, 16.6, 73.5, and 0.9, respectively. Excellent or good Constant outcomes were recorded in 89.6% of patients. Sixteen complications (7.9%) occurred, including nerve injuries (4.0%) and pseudoarthrosis (1.5%). Patients operated within 48 h had significantly better functional scores compared to those treated later (p < 0.01). No differences were found according to fracture pattern, sex, diabetes, or osteoporosis. Age showed a weak correlation with functional outcomes. Conclusions: IMN is a safe and effective option for the treatment of HSFs, with high rates of functional recovery and a low incidence of complications. Early surgical intervention appears to improve outcomes, supporting its role as a valuable strategy in HSF management. Full article

Adding a fibular strut bone graft to locking plate fixation has been introduced to improve stability and prevent varus collapse. The purpose of this study was to perform finite element analysis (FEA) of the biomechanical characteristics of different insertion angles of the fibular strut graft in proximal humerus fractures. Proximal humerus fractures with metaphyseal comminution and instability were simulated by creating wedge-shaped osteotomies medially and laterally for varus and valgus models, respectively. Three-dimensional finite element models were reconstructed from computed tomography images. A locking compression plate with a length of 90 mm (three holes) was applied to the proximal humerus fracture model. Fibular allografts were inserted at 0° and 30° to the humeral shaft. Axial and traction forces of 70°, 90°, and 110° relative to the vertical axis were applied to each model to simulate stress on the plate and graft. At axial loads, stresses in both the plate and the graft were lower when the graft was inserted at 0° than at 30°. Under traction loads, plate stress was lower with 30° insertion. Graft stress was also lower with 30° in most experimental conditions in both the valgus and varus models. These findings suggest that oblique insertion may provide biomechanical advantages under traction forces in unstable proximal humerus fractures. Full article

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

Background: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. Methods: This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. Results: Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups (p = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, p = 0.03). However, intraoperative blood loss (p = 0.36), Mayo Elbow Performance Score (p = 0.71), range of motion (p = 0.36), and complication rates (p = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group (p = 0.17), and four cases required implant removal due to discomfort (p = 0.18) in the anterolateral group. Conclusions: Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection. Full article

Background: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. Methods: A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. Results: Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1–46 months) with a mean follow-up of 37 months (range: 0.5–516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension–flexion arc was 2.1° to 127.8° (range: −10–140°). The mean Bauman’s angle was 72.4° (range: 66–79°), the mean shaft–condylar angle was 43.8° (range: 25–59°), the mean humeral length was 21.9 cm (range: 15.5–25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus–19° valgus). According to Flynn’s criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome (p = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction (p = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction (p < 0.001). Conclusions: Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate. Full article

Background: Humeral shaft fractures are relatively common. Complications associated with this type of fracture and its treatment include nonunion and radial nerve palsy. Plate osteosynthesis with autologous bone grafting is considered the gold standard for treating nonunion. However, bone grafts might not always be necessary in cases of hypertrophic nonunion, and treatment should be tailored to the specific type and characteristics of the nonunion. The treatment of radial nerve palsy is debated, with some favoring expectant management based on the nerve’s ability to regenerate, and others preferring early surgical exploration to prevent possible lasting nerve damage. Methods: We present the case of a 46-year-old male patient with a six-year-old humeral shaft fracture resulting in hypertrophic nonunion. We treated the nonunion with anterograde intramedullary nailing without bone grafting. Postoperatively, the patient developed severe radial nerve palsy. After repeated electrophysiological studies, a decision was made to surgically explore the nerve 10 days after the nonunion surgery. The nerve was subsequently found to be intact and treated with neurolysis. Results: Bony union was shown at six months after nonunion surgery. Four months after the nonunion surgery, the patient started to show clinical signs of nerve recovery, and at 12 months he achieved nearly full clinical recovery of radial nerve function. Conclusions: Anterograde intramedullary nailing without autologous bone grafting may be considered an option for treating hypertrophic nonunion. The management of radial nerve palsy requires effective cooperation and communication between patient and physician. Further research is necessary to be able to better predict nerve recovery. Full article

The treatment for humeral shaft fractures (HSFs) is still controversial, consisting of a wide variety of orthopedic osteosynthesis materials that imply different grades of invasiveness. The aim of this study is to investigate the correlation between inflammatory blood-derived markers and the magnitude of the surgical procedure in young and middle-aged patients who sustained these fractures. Observational, retrospective research was conducted between January 2018 and December 2023. It followed patients diagnosed with recent HFSs (AO/OTA 12−A and B) and followed operative treatment. They were split in two groups, depending on the surgical protocol: group A, operated by closed reduction and internal fixation (CRIF) with intramedullary nails (IMNs), and group B, operated by open reduction and internal fixation (ORIF) with dynamic compression plates (DCPs). Statistically significant differences (p < 0.05) between the two groups could be observed in injury on the basis of surgery durations, surgical times, pre- and postoperative neutrophil-per-lymphocyte ratio (NLR), postoperative platelet-per-lymphocyte ratio (PLR), monocyte-per-lymphocyte ratio (MLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI) and aggregate inflammatory systemic index (AISI). The multivariate regression model proposed revealed that NLR > 7.99 (p = 0.007), AISI > 1668.58 (p = 0.008), and the surgical times (p < 0.0001) are strongly correlated to the magnitude of the surgical protocol followed. Using receiver operating characteristic (ROC) curve analysis, a balanced reliability was determined for both postoperative NLR > 7.99 (sensitivity 75.0% and specificity 75.6) and AISI > 1668.58 (sensitivity 70.6% and specificity 82.2%). Postoperative NLR and AISI as inflammatory markers are highly associated with the magnitude of surgical trauma sustained during humeral shaft fracture osteosynthesis in a younger population. Full article

Background: This study investigates the surgical state-of-the-art procedure for humeral shaft fractures with primary radial nerve palsy based on its own case series in relation to the current and established literature. Methods: Retrospective review of treated cases between January 2018 and December 2022 describing radial nerve palsy after humerus shaft fractures, radiological fracture classification, intraoperative findings, surgical procedure, patient follow-up and functional outcome. Results: A total of 804 patients (463 women and 341 men) with humerus shaft fractures were identified. A total of 33 patients showed symptomatic lesions of the radial nerve (4.1%). The primary lesion was identified in 17 patients (2.1%). A broad and inhomogeneous distribution of fractures according to the AO classification was found. According to the operative reports, the distraction of the radial nerve was found eleven times, bony interposed three times and soft tissue constricted/compressed three times. In every case the radial nerve was surgically explored, there was no case of complete traumatic nerve transection. Four intramedullary nails and thirteen locking plates were used for osteosynthesis. Complete recovery of nerve function was seen in 12 cases within 1 to 36 months. Three patients still showed mild hypesthesia in the thumb area after 18 months. Two patients were lost during follow-up. Conclusions: With this study, we support the strategy of early nerve exploration and plate osteosynthesis in humeral fractures with primary radial nerve palsy when there is a clear indication for surgical fracture stabilisation. In addition, early exploration appears sensible in the case of palsies in open fractures and secondary palsy following surgery without nerve exposure as well as in the case of diagnostically recognisable nerve damage. Late nerve exploration is recommended if there are no definite signs of recovery after 6 months. An initial wait-and-see strategy with clinical observation seems reasonable for primary radial nerve palsies without indication for surgical fracture stabilisation. Full article

(1) Background: Anatomically pre-contoured plates usually require only minimal or even no intraoperative contouring. For complex cases, such plates also assist the surgeon as an anatomical template during fracture reduction. In this study, we present our experience of using a 3D printing technology for the treatment of bicondylar humeral fractures in feline cadavers. (2) Methods: Surgeries were performed on 15 pairs of front limbs amputated at the scapula. The limbs were obtained from 15 adult cats without obvious pathology of the skeleton. After flexion of the elbow and subperiosteal elevation of the anconeus muscle, the humeral Y-T fractures were created using a bone chisel and mallet. A custom-made anatomically pre-contoured interlocking plate was used to reduce and stabilise the medial aspect of the humeral condyle to the humeral diaphysis. After reduction of the humeral condyle, a positional locking screw was then inserted from the medial to the lateral side and a straight 2.4/2.7 interlocking bone plate was used to stabilise the lateral part of the condyle to the humeral diaphysis. (3) Results: The length of the humerus ranged from 98.2 to 107.0 mm and did not differ significantly between the left and right bone. The diameter of the isthmus of the humeral condyle ranged from 5.2 to 5.5 mm and did not differ significantly between the left and right bone. In all 30 limbs, bicondylar fracture was accompanied by epicondylar comminution. In 7/30 limbs (4 left, 3 right) the fracture of the humeral shaft was also present. In the left limbs, the postoperative articular surface defect of the humeral condyle was small (<1 mm) in 11/15 cases, moderate (1–2 mm) in 2/15 cases and large (>2 mm) in 2/15 cases in which the condylar screw was incorrectly inserted. In the right limbs, the postoperative articular surface defect of the humeral condyle was small (<1 mm) in 14/15 cases and moderate (1–2 mm) in 1 case. (4) Conclusions: 3D printing and the technology of metal powder sintering offers a wide range of possibilities for the development of new surgical implants. The anatomically pre-contoured bone plate appears to be a valuable tool in the reduction and stabilisation of Y-T humeral fractures in adult domestic cats weighing 3.0 to 4.5 kg. Full article

(1) Background: Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) Methods: We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) Results: There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548–17.774; p = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Conclusions: Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient’s individual condition, fracture and lesion patterns, the surgeon’s experience, and comprehensive discussion between the surgeon and patient. Full article

Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint. Full article

Background and Objectives: Posterior fracture dislocations are rare. There is currently no uniformity regarding treatment. Therefore, outcomes are difficult to compare. We evaluated clinical and radiological outcomes of patients with humeral head posterior fracture dislocation treated with an open posterior reduction and then fixed with a biomechanically validated configuration of blocked threaded wires. Materials and Methods: 11 consecutive patients with humeral head three-part posterior fracture dislocation were treated by reduction through a posterior approach and fixed with blocked threaded wires. All patients were clinically and radiographically evaluated after a mean follow-up of 50 months. Results: The mean irCS was 86.1% (range: 70.5–95.3%). No significant difference was found between irCS at 6 and 12 months postoperatively and the final follow-up. Six patients noted their pain intensity as 0/10, three as 1/10, and two as 2/10. The postoperative reduction was considered as excellent in eight patients (Bahr’s criteria) and good in the remaining three; at the final follow-up, reduction was excellent and good in seven and four patients, respectively. The mean neck-shaft angles at FU 0 and at the final FU were 137° and 132°, respectively. No signs of avascular necrosis, non-union, and arthritis progression were seen. No recurrence of dislocation or posterior instability symptoms were reported. Conclusions: We believe that our very satisfactory results stem from: (1) the manual reduction of the dislocation through a vertical posterior surgical approach, which does not produce further osteocartilaginous damage of the humeral head; (2) no multiple perforations of the humeral head are performed; (3) the threaded wires have a smaller diameter than the screws, therefore they preserve the bone tissue of the humeral head; (4) deperiostization or further detachment of soft tissues are not expected; (5) the adopted and validated system is stable and limits translation, torsion, and the collapse of the humeral head. Full article

Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate system between 2008 and 2018, with a minimum 4-year follow-up. We collected demographic, fracture-related, pre- and postoperative clinical (carrying angle (CA), ROM), and radiological data (humeral-ulnar angle (HUA), Baumann angle (BA), shaft-condylar angle (SCA), lateral capitellohumeral angle (LCHA)), as well as data on complications and satisfaction at last follow-up. Fifteen patients were included, with a median follow-up of 81 (64–103) months. All the variables had improved significantly as follows: CA −16 (−18 to −9)°, HUA −16 (−19 to −12)°, BA −11 (−17 to −7)°, SCA 7.5 (3.3 to 13.8)°, LCHA −4.8 (−6.8 to 0.6), flexion 10 (0 to 24)°, and extension 10 (0 to 10)°. The annual correction rate in terms of HUA was 2.41° (1.9 to 3.2). There were 5 cases of aseptic screw loosening, 4 of them requiring replacement, without relation to age at surgery (p = 0.324). Most patients (86.67%) were satisfied, and a relationship was found with younger age at surgery (p = 0.037). In conclusion, preliminary results show that LDHH with the eight-Plate system is an effective technique for mild to moderate cubitus varus deformity correction in children. Patients should be advised of the relatively long duration of implant retention and the possibility of reoperation for screw replacement or implant removal. Full article

Introduction: The aim of this study was to create a novel complication classification for osteosynthesis-related complications following angular stable plating of the proximal humerus subsuming the influence of these complications on clinical outcome in relation to fracture morphology and consequent revision strategies. A total of 1047 proximal humerus fractures with overall 193 osteosynthesis-associated complications (24.5%) were included. The following complication types could be clarified: complication Type 1 is defined by mild varus (<20°) or valgus displacement of the humeral head without resulting in a screw cutout through the humeral head cortex. Type 2a is defined by varus displacement (<20°) of the humeral head associated with screw cutout through the humeral head cortex. Type 2b complication is limited to displacement of the greater tuberosity, lesser tuberosity, or both tuberosities. Complication Type 2c is defined by severe varus dislocation (>20°) of the humeral head with screw cutout at the humeral head cortex. Complication Type 3 describes a displacement of the angular stable plate in the humeral shaft region with associated shaft-sided screw cutout, while the position of the humeral head remains static. Complication Type 4 is characterized by the occurrence of AVN with or without glenoidal affection (4a/b). Clinical outcome according to the constant score was mainly affected by type 2–4, leading to a deteriorated result. Depending on the type of complication, specific revision strategies can be considered. Additionally, more complex fracture patterns fostered the incidence of complications. Full article

Background and Objectives: Intramedullary nailing (IMN) and angularly stable plating (ASP) are the most popular techniques for the stabilization of comminuted fractures of the proximal humerus, without either one being obviously superior. The aim of the study was to validate the functional outcomes of both stabilization techniques in the COVID-19 pandemic by comparing them with data obtained just before the pandemic, because the limitations of the COVID-19 pandemic are affecting several aspects of social and medical life—being afraid of the transmission of the infection, patients reduce their exposure to healthcare to absolutely essential emergencies. Moreover, working conditions in the operating theater have also become more restrictive. Materials and Methods: Investigations were performed on 112 adult patients with Neer’s three- and four-fragment fractures stabilized with IMN (64) and ASP (48). Treatment effects were validated six months after surgery based on radiographs for evidence of bone union, humeral neck–shaft angle (NSA) and implant placement. Limb function was assessed with the QuickDash and Constant–Murley scores. Data obtained from patients treated in the COVID-19 pandemic were compared with those obtained before the pandemic. Results: The healing of all fractures was satisfactory, but complications developed in six cases. Three patients required secondary interventions due to inadequate repositioning: one after IMN and two after ASP. Additionally, one ASP was complicated by the secondary destabilization of a primarily properly stabilized major tubercle, and in two cases by conflict of the protruding implant with the acromion. ASP was noted to provide better functional results during the COVID-19 pandemic according to the Constant–Murley score (p = 0.0048; Student’s t-test). No significant differences were observed in the pre-COVID-19 pandemic. Conclusions: Our results suggest that ASP is more beneficial for the stabilization of comminuted fractures of the proximal humerus during the COVID-19 pandemic. Full article