Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial (original) (raw)
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2021
Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted postoperative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group.
International Journal of Orthopaedics Sciences
Introduction: There is still no consensus regarding management of fracture shaft humerus. We performed a prospective and retrospective study to compare clinical and functional outcome of humerus shaft fracture fixation by Nail and Plate Material and Methods: The study was performed at tertiary care centre after taking necessary approval from institutional ethics committee. Fourty patients were followed up for minimum six months. Patients were followed up at 6 weeks, 12 weeks, and 16 weeks and at the end of six months. Plating as well as nailing patients were included in the study. Results: In this study age ranges from 19 to 74 years with an average 33.22 years. The overall mode of injury in both groups was Road Traffic Accident (RTA) in 34 (85%), Fall 2 (5%), other causes, including industrial injury, assault in 4 (10%) cases. Average time taken for radiological healing overall was 16.83 weeks. In the interlocking group 18.95 weeks and plating group 14.72 weeks. So the healing rate was relatively faster in the plating group as compared to the interlocking group. Conclusion: Clinical and functional outcome after fixation of fracture shaft of humerus by plate and nails both were better (assessed by ASES Scores) with less postoperative complications. Both the modalities of treatment i.e. Plating and Nailing are good as far as union of the fracture is concerned, but considering the functional outcome and rate of complications, we are of the opinion that Plating offers better result than Nailing which is compared and evaluated statistically.
Indian Journal of Orthopaedics Surgery, 2020
To evaluate the outcome of open reduction and internal fixation using locking compression plate for proximal humeral fractures, done at a tertiary care referral teaching super specialty hospital in Andhra Pradesh, India from 1 st may 2015 to 31 st may 2017. Materials and Methods: The study consists of 53 patients diagnosed with proximal humerus fractures which were treated by open reduction and internal fixation with locking compression plate in a week after trauma, with in the age group of 20-60 years were selected. All patients were preoperatively evaluated with radiographs and CT 3D reconstructions. Post operatively their prognosis assessed by 100 point Constant-Murley scoring system. After attrition, to loss of follow-up, 49 patients followed for minimum 1 year. Their results were analyzed including complications. Results: At the end of one year, sixteen patients (32.65%) had excellent outcome with scores between 86-100, twenty five patients (51.02%) were functionally good with scores between 70 and 85. Seven patients (14.28%) had scores between 56 and 70, which according to the literature is a fair result. One patient (2.04%) had scores less than 55 points and was graded poor. The Mean Constant-Murley shoulder score was 82.85, thereby falling in the good outcome category. Conclusion: The Proximal humerus Locking Compression plating (LCP) technique gives moderate to excellent results in cases with proximal humerus fractures, depending on the fracture pattern. Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. Good surgical results can only be obtained by vigorous physiotherapy imparted by an expert team and strong motivation from the patient side. The results obtained with using Locking Compression Plates (LCP) were comparable to Proximal Humerus InterLocking System (PHILOS) plates except for varus collapse being common complication while using former for internal fixation.
Journal of Society of Surgeons of Nepal, 2020
Introduction: Long bone fractures are among the most common orthopaedic injuries encountered. A fracture that fails to progress to union despite appropriate fixation and absence of complications presents a treatment dilemma to the surgeon. The usual solution of re-fixation with or without bone graft constitutes repeat exposure to surgery and its risks, as well as added morbidity and cost. Recent advances in molecular biology suggest Platelet rich plasma (PRP) may have bone forming potential. This study was done to determine whether PRP has any beneficial role in patients with delayed healing of long bone fractures. Methods: A prospective interventional study was done on patients arriving at the department of orthopaedic surgery of Kathmandu Medical College with delayed union of long bone fractures after internal fixation between January 2014 and January 2017. Patients were treated with local injection of group-matched PRP directly into the fracture gap and were followed-up for six m...
Journal of Evidence Based Medicine and Healthcare, 2019
BACKGROUND The aim of this study was to compare the locking compression plate (LCP) over dynamic compression plate (DCP) in the management of diaphyseal fractures of the humerus. 38 patients with diaphyseal fracture of the shaft of the humerus were randomized prospectively and treated by open reduction and internal fixation with LCP or DCP. 11 patients underwent internal fixation by LCP and 27 by DCP. Fixation was done through an anterolateral or posterior approach. The outcome was assessed in terms of the union time, union rate, functional outcome, ROM and the incidence of complications. Functional outcome was assessed using the Romen's et al series grading system. On comparing the results by tests of significance like Chi-square test, there was no significant difference in Romen's et al scores between the two groups (P>0.05). Though the average union time and recovery of ROM was found to be better for LCP as compared to DCP, it is not statistically significant. Complications such as infection were found to be higher with DCP as compared to LCP. This study proves that LCP can be considered a better surgical option for the management of diaphyseal fractures of the humerus as it offers a short union time and lower incidence of serious complications like infection. However, there appears to be no difference between the two groups in terms of the rate of union and functional outcome.
A fracture bone usually heals by the formation of new bone at the fracture site. Occasionally, only fibrous tissue is formed, when this happens both surgeon & patient are disappointed. The bone is a specialized form of connective tissue may account for its ability to heal by the formation of new bone. The humerus is a long bone connecting two important joints of upper limb-which has wide range of movement having very little bony stability in shoulder joint and distal elbow joint which is a uni axial hinge joint. This prospective study of "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" was carried out during the period of 1 st December 2018 to 31th May 2019 at Rajshahi Medical College Hospital, Rajshahi, Bangladesh. Sample size will be calculated by using following statistics = 384. Purposive sampling (nonrandomized) according to availability of the patients and strictly considering the inclusion and exclusion criteria. Data will be collected with a pre-tested structured questionnaire containing history, clinical examination, laboratory investigations, pre-operative, peroperative, postoperative follow up findings and complications. 16 Patients were selected by using non randomized sampling method. The age ranges from 28-60 years. The mean age of occurrence was 38.19 (+10.04) years. Motor vehicle accident was the commonest cause of fracture found in 81.25% cases. Second most common cause was fall from height (12.50%). Right side involvement was more (62.50%). Among the affected people ser\Tce holders and shopkeepers were commonest (25% each), next were businessmen and farmers (18.75% each). The mean union time was 16.38 (+2.78) weeks. Postoperative complications were noticed such as wound infection (6.25%) and shoulder pain (6.25%). There was no complication (81.25%). Functional outcome of this treatment was analyzed by Constant and Murley scoring 1999. Excellent functional outcome was found in 5 (31.25%) cases, good in 9 (56.25%) cases, fair in 1 (6.25%) case and poor in 1 (6.25%) case. Regarding the final outcome satisfactory result was found in 14 (87.50%) cases and unsatisfactory result in 2 (12.50%) cases. Based on the results shown above it is concluded that "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" is an effective modality of treatment for the nonunion of humeral shaft fracture and is especially recommended in osteoporotic bones and elderly patients with compromised bone quality.
Absolute or relative stability in plate fixation for simple humeral shaft fractures
Injury, 2019
Introduction: Minimal invasive plating (MIPO) techniques for humeral shaft fractures appear to have fewer complications and higher union rates compared to open reduction and internal fixation (ORIF). It is questionable if this also applies to simple humeral shaft fractures, as simple fractures are generally treated with absolute stability which cannot be obtained with MIPO. This raises the question whether biology or biomechanics is more important in fracture healing. This study was developed to investigate the biomechanical part of this equation. The aim of the study was to compare relative stability to absolute stability in simple humeral shaft fractures with regard to fracture healing Methods: This was a retrospective study of all patients treated with plate fixation for AO/OTA type A1-B3 humeral shaft fractures. Patients were categorized into two groups: absolute stability and relative stability. Both groups were compared with regard to time to radiological union and full weight bearing Results: Thirty patients were included in the relative-stability-group with either an AO/OTA type A (n = 18) or type B (n = 12) humeral shaft fracture and a mean age of 55 (SD 21) years. A total of 46 patients were included in the absolute-stability-group: 27 patients had a type A and 19 type B fracture. The mean age in this group was 45 (SD 19) years. Median follow-up was 12 months (IQR 8-13). Minimally invasive approach was used in 15 (50%) patients in the relative stability group. Time to radiological union was significantly shorter in the absolute-stability-group with a median of 14 (IQR 12-22) versus 25 (IQR17-36) weeks and HR 2.60 (CI 1.54-4.41)(p < 0.001). This difference remained significant after correction for type of approach (adjusted HR 3.53 CI 1.72-7.21) (p 0.001). There was no significant difference in time to full weight bearing. The addition of lag screws in the absolute stability group did not influence time to radiological healing or full weight bearing. Conclusion: Absolute stability for simple humeral shaft fractures leads to a significantly shorter time to radiological union compared to relative stability. The addition of lag screws to gain interfragmentary compression does not reduce fracture healing time.
International Orthopaedics, 2020
Purpose To compare the radiological and clinical outcomes of interlocking nail (ILN) and locking plate fixation (LCP) for humeral shaft fractures. Methods A total of 63 patients with displaced humeral shaft fractures between October 2014 and January 2017 were evaluated prospectively. They were divided randomly into two as LCP fixation (group 1) and interlocking nail (ILN) (group 2). Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles (UCLA) shoulder scores, and Short Form-36 (SF-36) questionnaires, and pain was assessed with visual analogue scale (VAS). Results After fracture callus was radiologically observed, DASH, ASES, and UCLA scores as well as SF-36 questionnaires and VAS results were noted to have no significant difference between the two groups (p = 0.109, p = 0.082, p = 0.146, p = 0.322, and p = 0.175, respectively). At the last follow-up (post-operative 24 months), the UCLA score was significantly better in group 1 (p = 0.034), whereas VAS result was significantly worse in group 2 (p = 0.017). DASH, ASES scores, and SF-36 questionnaires had no difference (p = 0.193, p = 0.088, p = 0.289). Other parameters revealed no significant differences. Fracture consolidation was observed at a mean of four months in both groups (3 to 7 months in group 1 and 3 to 8 months in group 2) (p = 0.189). Four patients in group 1 and five patients in group 2 underwent surgery for nonunion (p = 0.725). Post-operative radial nerve palsy was seen in one patient in group 2. Two patients in group 1 with superficial infection were treated with antibiotics, and they recovered. Conclusions Regarding our results, the LCP group had significantly better shoulder function than the ILN group, whereas the ILN group had significantly less pain, with similar complication rates. Therefore, both procedures are favourable surgical options for patients with humeral shaft fractures.
Background:The purpose of this prospective study is to compare the functional outcomes of method of fixation (dynamic compression plating and interlocking nailing) for the fracture shaft of humerus and to analyze the difference in the results of these two methods. Materials and Methods: A prospective comparative study of 26 patients with diaphyseal fracture of humerus (age range18-60), half of the patients (group A) treated with Intramedullary Interlocking Nailing and another half group of patients (group B) treated with Narrow DCP in the Results:The functional outcome and range of motion of shoulder and elbow were assessed by RODRIGUEZ MERCHAN CRITERIA. In Group A (Interlocking Nail), range of movement of shoulder and elbow joints were excellent in 61.54%(8), good in 23.07%(3) and fair in 15.39%(2) of cases whereas in Group B (Narrow DCP), range of movement of shoulder and elbow joint were excellent in 84.62%(11), good in 7.69%(1) and fair in only 7.69%(1) of cases. Conclusion:Though both modalities of treatment provide comparable union rates, narrow DCP is an effective and safe alternative for treatment of diaphyseal fractures of humerus.