To provide the scientific theoretical basis for cl inical practice by comparing biomechanicalcharacteristics of single compressed plate with intramedullary pin, locking intramedullary nail and simple arm externalfixator with simple internal fixation devices. Methods Eighteen wet humeral bone specimens of adult cadaver were madecompl icated fracture models of humeral shaft and divided into 3 groups according to fixation methods. Fracture was fixed by single compressed plate with intramedullary pin in plate group, by locking intramedullary nail in intramedullary nail group and by external fixator with simple internal fixation devices in external fixator group. The intensity and rigidity of compl icated fracture models of humeral shaft was measured in compress test and torsion test. Results In compress test, the maximum load in plate group (6 162.09 ± 521.06) N and in intramedullary nail group (6 738.32 ± 525.89) N was significantly larger than that in external fixator group (2 753.57 ± 185.59) N (P lt; 0.05); but there was no significant difference between plate group and intramedullary nail group (P gt; 0.05). Under 600 N physiological compress load, the rigidity was (171.69 ± 6.49) N/mm in plate group, (333.04 ± 36.85) N/mm in intramedullary nail group and (132.59 ± 2.93) N/mm in external fixator group; showing no significant difference between plate group and external fixator group (P gt; 0.05), and showing significant difference between intramedullary nail group and plate, external fixator groups (P lt; 0.05). In torsion test, the maximum torque in plate group (38.24 ± 7.08) Nm was significantly larger than those in intramedullary nail group (17.12 ± 5.73) Nm and external fixator group (20.26 ± 6.42) Nm (P lt; 0.05), but there was no significant difference between intramedullary nail group and external fixator group (P gt; 0.05). Under 0.80 Nm physiological torque, the rigidity was (16.36 ± 2.07) Ncm/° in plate group and (18.79 ± 2.62) Ncm/° in external fixator group, which was significantly larger than that in intramedullary nail group (11.45 ± 0.22) Ncm/° (P lt; 0.05); but there was no significant difference between plate group and external fixator group (P gt; 0.05). Conclusion Those fracture models fixed by single compressed plate with intramedullary pin have better compress and torsion intensity, they also have better torsion rigidity but less compress rigidity. Those fracture models fixed by locking intramedullary nail have better compress intensity but less torsion intensity, they also have better compress rigidity but less torsion rigidity. Those fracture models fixed by external fixator with simple internal fixation device have less compress and torsion intensity, they also have less compress rigidity but better torsion rigidity.
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.
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 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.
Objective To determine the efficacy and complication rate of intramedullary nailing versus compression plate in the treatment of adult humeral shaft fracture. Methods We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group, The Cochrane Library (including CENTRAL), MEDLINE (1966 to 2006), EMbase (1980 to 2006), PubMed (1966 to 2006), NRR , CCT and CBMdisc (1979 to July 2006). We also handsearched some Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomize controlled trials comparing intramedullary nailing versus compression plate for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were done using The Cochrane Collaboration’s RevMan 4.2.8. Results Three randomize controlled trials involving 215 patients were included. The meta-analysis showed that intramedullary nailing may increase the re-operation rate (OR=2.68, 95%CI 1.19 to 6.04, P=0.02), pain in the shoulder (OR=13.02, 95%CI 2.23 to 75.95, P=0.004), and the rate of decreased range of motion of the shoulder (OR=18.60, 95%CI 1.01 to 341.83, P=0.05). The rates of no union, infection and iatrogenic radial nerve injury were comparable between intramedullary nailing and compression plate. Meta-analysis was not conducted for the time of union, because the relevant data were not available for the included trials. Conclusions Further well-designed and large-scale randomize controlled trials are required to determine the effects of intramedullary nailing and compression plate on these outcomes, because the trials available for this systematic review are too few and too small.
Objective To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C. Methods Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P gt; 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. Results The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P lt; 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (χ2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 ± 0.75) weeks in LCP group and (11.38 ± 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P lt; 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P gt; 0.05). There was no significant difference in shoulder function and elbow function at 1 year after operation between 2 groups (P gt; 0.05). Conclusion LCP fixation and IMN fixation for humeral shaft fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
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 compare the effectiveness of anterior and lateral approaches of minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. MethodsThe clinical data were retrospectively analyzed and compared from 35 cases of humeral shaft fractures between January 2010 and December 2012. The patients underwent MIPO by anterior approach in 17 patients (group A) and by lateral approach in 18 patients (group B). There was no significant difference in gender, age, injury causes, type of fractures, and time from injury to operation between 2 groups (P>0.05). The operation time, fracture healing time, intra- or postoperative complications, and shoulder and elbow range of motion (ROM) values were recorded and analyzed. The functions of the affected shoulder and elbow were assessed with the University of California Los Angeles (UCLA) and Mayo elbow performance score system respectively. ResultsThe operation time was (91.35±8.00) minutes and (95.56±7.92) minutes in groups A and B respectively, showing no significant difference (t=-1.561, P=0.128). Incision healed by first intention in all patients of 2 groups. No iatrogenic radial nerve palsy occurred in group A, 2 cases had postoperative iatrogenic radial nerve palsy in group B, showing no significant difference (P=0.486). The patients were followed up 15.4 months on average (range, 11-24 months) in group A and 16.8 months on average (range, 10-23 months) in group B. The X-ray films showed bony healing in all patients. The fracture union time was (13.5±2.1) weeks in group A and (14.0±2.2) weeks in group B, showing no significant difference (t=-0.696, P=0.491). The UCLA scores were 33.4±1.9 in group A and 30.6±2.0 in group B, and the Mayo elbow performance scores were 100 in group A and 96.4±2.8 in group B; all showed significant differences (t=4.231, P=0.000; t=5.293, P=0.000). ConclusionGood clinical outcomes could be obtained when humeral shaft fractures are treated with MIPO either by anterior approach or by lateral apporach. However, anterior approach could offer better shoulder and elbow functional results.