Minimally invasive treatment of pathological fractures of the humeral shaft (original) (raw)
Related papers
Revue de Chirurgie Orthopédique et Traumatologique, 2018
Hypothesis.-This study assessed: if there was a difference in surgical decision making for metastatic humeral lesions based on orthopaedic subspecialty and tumor characteristics. Study type.-Cross-sectional survey study. Materials and methods.-Twenty-four case scenarios were created by combining: tumor type, life expectancy, fracture type, and anatomical location. Participants were asked for every case: what treatment would you recommend? Participants were 78 (48 %) orthopaedic oncologists and 83 (52 %) orthopaedic surgeons that were not regularly involved in the treatment of bone tumors. Results.-There was a difference between orthopaedic oncologists and other subspecialty surgeons in recommendation for specific treatments: intramedullary nailing was less often recommended by orthopaedic oncologists (53 %, 95 % CI: 47-59) compared to other surgeons (62 %, 95 % CI: 57-67) (p = 0.023); while endoprosthetic reconstruction [orthopaedic oncologists: 8.8 % (95 % CI: 6.6-11), other surgeons: 3.6 % (95 % CI: 2.3-4.8), p < 0.001] and plate-screw fixation [orthopaedic oncologists: 19 % (95 % CI: 14-25), other surgeons: 9.5 % (95 % CI: 5.9-13), p = 0.003] were more often recommended by orthopaedic oncologists. There was no difference in recommendation for non-operative management. There were differences in recommendation for specific treatments based on tumor type, life expectancy, and anatomical location, but not fracture type. Discussion.-Subspecialty training and patient and tumor characteristics influence the decision for operative management and the decision for a specific implant in metastatic humeral fractures. Level of evidence.-Level III.
Surgical Treatment of Pathological Fractures of the Shaft of the Humerus
Journal of Trauma: Injury, Infection & Critical Care, 2009
To analyze the results of surgical treatment for pathological fractures at the proximal femur. Materials and Methods: Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. Results: The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. Conclusion: Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.
Which Surgical Treatment is Preferable in Humeral Diaphyseal Fractures? A Systematic Review
Orthopedic Reviews
Introduction Humeral diaphyseal fractures are very common. Many treatments have been proposed but the choice of the best one is often complex. Objective The aim of the proposed study is to analyze the data in the literature in order to define the risks, advantages and disadvantages of the alternative surgical treatments (anterograde/retrograde intramedullary nailing, ORIF, MIPO). Methods PubMed / Medline and Google Scholar were searched for prospective randomized or case-control retrospective studies about surgical treatment of humeral diaphyseal fractures with nailing, ORIF and MIPO, according to PRISMA guidelines. The primary outcome considered was the fracture healing time by comparing nailing-ORIF, nailing-MIPO and ORIF-MIPO. Differences in the rate of post-operative complications, patient satisfaction, intra-operative blood loss and surgical time were considered secondary outcomes. Results 506 studies were identified, but only 10 studies were valid for the systematic review. No...
Percutaneous Intramedullary Nailing in Adult Diaphyseal Humeral Fractures
Aims and Objectives: Fractures of Humerus can be treated conservativel,, but often present problems of compliance. malunion, delayed /nonunion needing intervention. One option for fixation of these fractures is closed fixation by multiple flexible intramedullary nails. A prospective study was undertaken to study this method of treatment. Materials and Methods: In two private hospitals over a period of 7 years, 132 patients of fracture humerus shaft were fixed with multiple (3 to 5) slender flexible nails—71 by rush nails and 61 by ender nails and followed up from 5 months to 42 mths and assessed clinically for range of movements, pain and deformity and radiologically for union. Results: Results were assessed at 6 months and again at the time of implant removal. Satisfactory results were seen in 87% cases at 6 months with primary union in 107 cases. There were 19 non/-delayed unions, which eventually healed after a second surgery-bone grafting in 12 and bone marrow injections in 7. 6 patients were lost to follow up before union and were included in the poor results. The commonest complication observed was shoulder stiffness the incidence of which reduced dramatically after the insertion site of the nails was revised during the study. Conclusions: Closed intramedullary nailing for the humerus offers many advantages such as minimal tissue trauma, short surgical time, short hospital stay, economy and early union.
Medical Archives
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.
The effectiveness of intramedullary nailing in humeral diaphysis fractures and non-unions
Pamukkale Medical Journal
Purpose:The analysis of treatment results of humeral non-unions with intramedullary nailing (IMN) according to primary treatment is not argued convincingly in literature. Materials and methods: The results of 39 patients who treated with intramedullary nailing for humerus diaphysis fracture or non-union analysed in this study. An antegrade IMN technique was used with an interlocking intramedullary nail (Russell-Taylor type) in all cases. Twenty-six of these patients had primary IMN, seven had revision for failed plating and six had exchange IMN. Results:The non-union rate was 15% in primary IMN, 29% in the revision for failed plating and 83% in exchange IMN groups. The average time to union were found as 14 weeks in the primary IMN and 20 weeks in the revision for failed plating. Even though revision for failed plating had similar healing rate with primary IMN (p>0.05), the healing time significantly increased. (p<0.05) The exchange IMN had the worst results. (p<0.05 against other groups). Conclusion: IMN for humeral shaft fracture may be considered as an effective method of primary treatment. Exchange IMN in the humerus seemed to be a non-effective treatment modality and should be better to be avoided. In contrast IMN for a non-union after failed plating is an effective treatment. The non-unions of humerus shaft should be better to be treated with changing the implant type.