A study of 40 cases of diaphyseal fracture of shaft of the humerus treated with plate osteosynthesis

Abstract

Introduction: Different modalities of treatment are available for fracture shaft of humerus. It includes various conservative methods like immobilization in a sling, Thomas arm splint, U slab, hanging cast, shoulder spica cast and surgical treatment such as intramedullary nailing, plate osteosynthesis, and external fixator. These different methods have their own advantages and disadvantages. Method of plate osteosynthesis is sometimes associated with infection and iatrogenic damage to radial nerve. The selection of a method for treating fracture shaft of the humerus depends on various factors which are related to patient and type of fracture. We decided to undertake the study of fracture shaft humerus treated with plate osteosynthesis. Aim: To study patients with diphyseal fracture of shaft of the humerus treated with plate osteosynthesis. Materials and Methods: This was a prospective study of 40 patients with diaphyseal fractures of humerus treated by plate osteosynthesis. All the patients were treated as indoor patients at the Department of Orthopaedics, New Civil Hospital, Surat from January, 2004 to March, 2006. The maximum period of follow-up was 2 years and the minimum period of follow-up was 5 months with average follow-up of 6 months. Patients were operated as soon as they were fit for surgical procedure under anaesthesia. An informed written consent was taken. Most of the patients were operated by posterior approach except two operated through anterolateral approach. AO type narrow 4.5mm dynamic compression plates with 4.5mm cortical screws were used. Patients were called for follow-up regularly at interval of 2-4 weeks as per need. At each visit, patients were examined for pain, tenderness, skin condition, elbow and shoulder movements. All the findings were recorded. Final results were evaluated as per criteria laid down by Hunter. Results and discussion: In the present series, 88% had excellent to good results which were almost consistent with the series reported by Dominik Heim et al. One patient had superficial infection which responded to daily dressing and proper antibiotic use. In Robert and Vander series, postoperative infection rate was 5.6%. In our study, 2 patients had radial nerve palsy at the time of trauma and 1 patient had postoperative radial nerve palsy. Usually, these injuries are neuropraxia. All 3 patients had full recovery within 3-4 months. Conclusion:Though the series is relatively small and the period of follow-up is small, however it appears that: Plate fixation appears to be a good surgical option for treatment of the diaphyseal fractures of humerus. Radial nerve palsy is usually of neuropraxia and it recovers within 4-6 months.