Surgeons should be aware as well as patients should be informed that as many as 4% are offered or request a second surgery, usually for persistent pain and often within the 1-year window when additional improvement is anticipated.

BackgroundUnderstanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection and lead to devascularization and bad outcomes. Few studies have looked at the humerus, and no studies have described relative information of humeral nutrient foramen related to anatomical structures that might be located by palpable landmarks. In this study, we analyzed the anatomical features of the nutrient foramina of the diaphyseal humerus and provide a discussion of clinical relevance.Material/MethodsWe dissected 19 cadavers and analyzed the relative positions of the foramina and surrounding muscles, and the number, direction, diameter, and location of the nutrient foramina. Foramina index and a new landmark index were used to calculate the location. We compared the data from both sides and the relationships between transverse and longitudinal locations, diameter and total length, and foramina index and landmark index were also analyzed.ResultsThe humeri had one or two main nutrient foramina located in a small area between the coracobrachialis and brachial muscles and oriented toward the elbow. The mean diameter was 1.11±0.32 mm. The mean index and landmark index were 43.76±4.94% and 42.26±5.35%, respectively. There were no differences between sides in terms of diameter, length, or nutrient foramina index. There were no significant correlations between transverse and longitudinal locations or diameter and total length. The foramina index and landmark index showed strong positive correlation (r=0.994, p<0.0001).ConclusionsOur study provides details about the nutrient foramina that will benefit clinicians who treat injuries and diseases of the humerus. Surgeons should be mindful of soft tissue in the foraminal area during surgical procedures.

BackgroundHumeral shaft fractures are generally managed with the conventional posterior open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This study was aimed at comparing the outcomes of these surgical techniques in terms of the vascular integrity of the mid-distal humeral shaft.MethodsTwelve upper limbs were harvested from 6 fresh cadavers. ORIF or MIPO was randomly performed on either side of each pair of limbs. The axillary artery was perfused with a latex-lead tetraoxide red solution to visualize the vascular structures. The vascular integrity of the humerus was examined by plain radiography and dissection. The periosteal filling achieved with each technique was scored and the scores compared.ResultsIn each limb, one main nutrient artery entering the mid-distal humeral shaft anteromedially (83.3 %) or medially (16.7 %) was first identified. No case of injury to the main nutrient artery was noted for either surgical technique. Injuries to the accessory nutrient arteries entering the mid-distal humeral shaft from the posterior aspect were absent in the MIPO cases, but occurred in 52.9 % of the ORIF cases. In addition, MIPO was also superior to the open plate technique showed superior periosteal filling than.ConclusionsOur results showed that the MIPO technique is superior to the ORIF in terms of preserving the vascular integrity of the mid-distal humeral shaft.