Fractures of the Distal Humerus (original) (raw)
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Appropriateness of fixation methods - Trauma Meeting 2019: humeral diaphysis
Lo Scalpello - Otodi Educational, 2020
Humeral shaft fractures account for about 1-3% of all fractures in adults and are classified according their location, open or closed status and the pattern of fracture lines. Conservative treatment with functional bracing has been the most widely accepted treatment option in the last decades, however an increasing number of patients is treated surgically. This article overviews the indications, pros and cons of the most used fixation methods. Plates and nails are the most used devices, have widely overlapping indications, mostly depending on surgeon's preference. Plate fixation can be used for almost all humeral fractures and represent the best option for transitional fractures (proximal or distal shaft), particularly those with intra-articular involvement. MIPO techniques combines the advantages of plates with less soft tissue impairment. Fractures associated with nervous lesions deserve special considerations: the need to explore the radial nerve can drive the choice of implant more than the fracture itself. Intramedullary implants are the best option for pathological fractures of the humeral shaft, and can appropriately replace plates fixation for middle third or proximal shaft even with intra-articular simple patterns. External fixation is rarely indicated, mainly for damage control and/or extensive soft tissue damage.
Surgical management of Fracture Humerus
2016
Fracture shaft of the humerus is a major injury commonly resulting from Road Traffic Accident. It is associated with multiple fractures because of high velocity trauma of R T A. Although the close reduction is ideal, the O.R. + I.F. with plating is treatment of choice in certain indications. The DCP plating has an advantage over the ASIF type of plates in securing rigid fixation and early mobilisation with out any external splintage. Full attention to the training and familiarity with the proposed procedure will yield good operative results. Poor technique of fixation often results in poor results. The complication of infection can be prevented with aseptic precautions, pre-op preparation, pre-per and post-op antibiotics and above all meticulous dissection and minimum soft tissue damage. Early mobility of the limb is responsible for excellent results and is good for fracture and joints and for the patient. Early return to the jobs thus saves the patients from economic setbacks is po...
(i) Plate fixation of proximal humeral fractures
Orthopaedics and Trauma, 2013
Proximal humeral fractures account for about 5% of all fractures with a peak incidence in females aged over 80 and the incidence of these fragility fractures expected to increase. Whilst the majority can be conservatively managed, those with displaced fractures may benefit from surgery.
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.
" Management of Distal Humerus Fractures
Back ground: The management of distal humerus fractures has been improved over the last few years due to more common use of advanced imaging modalities such as computed tomography (CT), understanding the benefits of parallel-plating techniques, the recognition of the more complex patterns of shear fractures of the articular surface of the distal humerus, the widespread use of precontoured periarticular plates, and the selective use of elbow arthroplasty. Methodology: this study was done in Government General HospitalSiddhartha Medical College Vijayawada. It is a prospective study.done from December 2015 to June 2017,in 20 members of patients. All surgeries were performed by single orthopaedic surgeon at Government General Hospital / Siddhartha Medical college. The type of fracture, time delay for surgery, surgical approach, complications and outcome were recorded. based on inclusion and exclusion criteria. Results: In the present study of 20 cases the average age was 35 years. The youngest age was 21 years and oldest age was 55 years. The Male/ Female ratio was 1.85:1. In present study 12 cases sustained dominant hand injuries. Fractures sustained in a road traffic accident(most common) were more comminuted. Shin SJ et al 1 compared clinical outcomes in patients with intraarticular distal humerus fractures using 2 different double plating methods. 17 patients were treated by orthogonal plating and 18 patients were treated by parallel plating. Arc of flexion, bone union was better in parallel plating compared to orthogonal plating. 2 Patients were follow-up for an average of 8months (range 3 months to 15 months). Excellent results were found in 8cases (40%); Good results in 7 cases (35%), sum of excellent to good results of 15 cases (75%) and fair results were obtained in 5(25%) cases. In present study the functional Flexion-Extension arc gained was at an average of 100 0. No post operative permanent nerve palsies were found except transient ulnar nerve palsy in one case, which was managed conservatively which recovered completely.In this study hardware pain was noticed in 2 patients. In them proud k-wires were removed after union. We had one case of deep Infection for which we did a thorough lavage and treated the patient with high end antibiotics. The patient recovered the fracture united but the patient had elbow stiffness with functional range of motion. Conclusion:1 In the surgical management of fractures of the distal humerus anatomical reduction of the articular surface, rigid and stable internal fixation of the distal humerus medial and lateral pillars and accurate reconstruction of the trochlea and capitellum are of prime importance in achieving an excellent functional outcome.2.For open reduction and internal fixation of fractures of the distal humerus, we got similar results with Triceps Reflecting Anconeus Pedicle, Triceps-splitting and Olecranon Osteotomy approach Parallel plating of medial and lateral pillars is the preferred technique by us to have a stable and rigid anatomical construct allowing early mobilization.