Functional outcome following fixation of fractures shaft of humerus - intramedullary nailing versus plate osteosynthesis: A comperative study

Hassan, Muhammad Umair; Ikbal, Faizal M; M, Abdul Hakeem; MC, Janees; Purushothaman, Vivek; E, Mohammad Mohsin; Arif,; Hussain, Avad; Sreeraj,; KM, Shaan

doi:10.22271/ortho.2022.v8.i2e.3160

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Fifteen of the included studies were level I RCTs, 6 level II RCTs, and 4 level II prospective multicenter studies. 21–45 The ROB/methodologic quality of evidence was evaluated for all studies (4 low ROB, 13 medium ROB, 8 high ROB). The mean patient age was 40.2 years, range 15–88 years.…”

Section: Resultsmentioning

confidence: 99%

Management of Humeral Shaft Fracture: A Network Metanalysis of Individual Treatment Modalities

Colasanti,

Anil,

Cerasani

et al. 2024

Journal of Orthopaedic Trauma

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Objective: The purpose of this study was to perform a network meta-analysis (NMA) of level I and II evidence comparing different management techniques to define the optimum treatment method for humeral shaft fractures (HSF). Methods: Data Sources: A systematic review of the literature using PRISMA guidelines of MEDLINE, EMBASE, and Cochrane Library was screened from 2010-2023. Study Selection: Inclusion criteria were evidence level I or II studies comparing nonoperative and/or operative repair techniques including open reduction internal fixation plate osteosynthesis (ORIF-Plate), minimally invasive percutaneous plating (MIPO), and intramedullary nail fixation (IMN) for the management of HSF (AO OTA 12A,B,C). Data Extraction: The risk of bias (ROB) and methodologic quality of evidence (MQOE) were assessed according to the guidelines designed by the Cochrane Statistical Methods Group and Cochrane Methods Bias Group. Data Synthesis: NMA were conducted with a frequentist approach with a random effects model using the netmeta package version 0.9-6 in R. Results: A total of 25 studies (1,908 patients) were included. MIPO resulted in the lowest complication rate (2.1%) when compared to ORIF-Plate (16.1%) (OR, 0.13;95%CI,0.04-0.49). MIPO resulted in the lowest nonunion rate (0.65%) compared to all management techniques (OR 0.28; 95%CI, 0.08-0.98), whereas Non-Op resulted in the highest (15.87%) (OR,3.48; 95%CI, 1.98-6.11). MIPO demonstrated the lowest rate of postoperative radial nerve palsy overall (2.2%) and demonstrated a significantly lower rate compared to ORIF-Plate (OR,0.22,95% CI, 0.07-0.71, p=0.02). IMN resulted in the lowest rate of deep infection (1.1%) when compared to ORIF-Plate (8.6%; p=0.013). MIPO resulted in a significantly lower DASH score (3.86±5.2) and higher ASES score (98.2± 1.4) than ORIF-Plate (19.5±9.0 & 60.0±5.4, p<0.05). Conclusion: The results from this study support that surgical management results in better postoperative functional outcomes, leads to higher union rates, reduces fracture healing time, reduces revision rate and decreases malunion rates in patients with HSFs. Additionally, MIPO resulted in statistically higher union rates, lowest complication rate, lowest rate of postoperative radial nerve palsy, and lower intraoperative time, while resulting in better postoperative DASH and ASES scores when compared to nonoperative and operative (ORIF & IMN) treatment modalities. Level of Evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Management of Humeral Shaft Fracture: A Network Metanalysis of Individual Treatment Modalities

Colasanti,

Anil,

Cerasani

et al. 2024

Journal of Orthopaedic Trauma

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Evaluation of Functional and Radiological Outcomes of Humeral Shaft Fracture Treated With Locking Compression Plate

Bandaru¹,

Shanthappa²

2023

Cureus

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BackgroundThe best surgical procedure for humeral shaft fractures is still plate and screw fixation. Researchers have shown that plate fixation lessens the occurrence of malunion and nonunion. This study aims to describe the functional and radiological outcomes of a humerus shaft fracture treated with a locking compression plate (LCP) using the visual analog scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) scoring systems. MethodFrom December 2020 to July 2022, 25 patients with humerus shaft fractures were enrolled in the prospective observational study at RL Jalappa Hospital, which is affiliated with Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar. We have included closed and open type 1 fractures as per the Gustilo-Anderson classification and excluded humerus shaft fractures associated with neurovascular injury, pathological fractures, and ipsilateral upper limb long bone (radius and ulna) fractures. For a humerus shaft fracture, open reduction and internal fixation (ORIF) + LCP was done on patients who were fit for surgery, had normal test results, and were given the right kind of anesthesia. Every six weeks, every three months, and every six months, patients had regular reviews. A check X-ray was taken each time a patient attended, and we assessed them clinically and radiologically for fracture union, functional outcome, and comorbidities. The patient's DASH and VAS ratings were assessed at the follow-up visit. The Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Armonk, NY, USA) was used to analyze the data. ResultThe mean age of the study participants was 33 years, with a standard deviation of 8.9 years. Among the study participants, about 60% of the individuals were males. About 40% of the individuals had injuries due to motorcycle accidents, and 88% of the individuals had direct injuries. Only 12% of the individuals had disease complications. This study recorded a 100% union rate among the study samples. Among the study participants who have histories of hypertension, closed fractures have shown significant improvement according to VAS scores. Among the study participants who were males, those who presented with indirect injury, no history of fracture, right side involvement, and absence of complications showed significant improvement according to the DASH score. ConclusionLCP is reliable for the union of fractures in patients of any age and activity level since we can use it at all levels of the humeral shaft and can achieve 100% union when used with the right principles and osteogenic stimulus. LCPs repair humeral shaft fractures well because they can achieve good functional and radiological results and have few adverse effects.

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Functional outcome following fixation of fractures shaft of humerus - intramedullary nailing versus plate osteosynthesis: A comperative study

Cited by 2 publications

References 10 publications

Management of Humeral Shaft Fracture: A Network Metanalysis of Individual Treatment Modalities

Management of Humeral Shaft Fracture: A Network Metanalysis of Individual Treatment Modalities

Evaluation of Functional and Radiological Outcomes of Humeral Shaft Fracture Treated With Locking Compression Plate

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