Functional treatment of closed humeral shaft fractures

Toivanen, Jarmo; Nieminen, Jyrki; Laine, Heikki-Jussi; Honkonen, Seppo E.; Järvinen, Markku

doi:10.1007/s00264-004-0612-8

Cited by 114 publications

(72 citation statements)

References 19 publications

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“…In contrast, nonunion is disabling because of pain and instability [6][7][8][9] . In prior studies, risk factors for nonunion were found to be open fractures, transverse mid-diaphyseal fractures (AO type A3), and spiral fractures (AO type A1) in the proximal part of the shaft 1,[10][11][12][13] . Sarmiento et al 1 observed a persistent gap between the fracture fragments in seven of sixteen patients with a nonunion after functional bracing of a humeral shaft fracture but did not quantify the risk of nonunion associated with a fracture gap.…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion criteria were (1) a closed fracture, (2) an AO type-A2 (oblique, ‡30°) or type-A3 (transverse, <30°) fracture, (3) a fracture in the middle third of the diaphysis, (4) no periprosthetic or peri-implant (nail or plate) fracture, (5) nonoperative treatment, and (6) either documented union (clinically and radiographically) two months or more after injury or a recommendation for surgery based on persistent motion between the fracture fragments and a persistent fracture line found on radiographs obtained six weeks or more after injury 13 . Of the eighty-two patients who fulfilled the inclusion criteria, three were excluded because they had had surgical treatment within three weeks after injury.…”

Section: Patient Selectionmentioning

confidence: 99%

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Risk Factors for Fracture Mobility Six Weeks After Initiation of Brace Treatment of Mid-Diaphyseal Humeral Fractures

Neuhaus

Menendez

Kurylo³

et al. 2014

Journal of Bone and Joint Surgery

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BACKGROUND: Recent studies have identified specific subsets of diaphyseal humeral fractures for which functional bracing is less effective. The present study tested the hypothesis that a gap between fracture fragments may be a risk factor (after accounting for other potential risk factors) for fracture instability six weeks after functional bracing of humeral shaft fractures. METHODS: We retrospectively identified seventy-nine adult patients (forty-six men, thirty-three women; forty-two fractures on the right side, thirty-seven fractures on the left), each with an acute, closed, AO type-A2 (oblique, 30°) or type-A3 (transverse, lt;30°) mid-diaphyseal humeral shaft fracture treated nonoperatively at three different level-I trauma centers from June 2004 to August 2011. The gap between the fracture fragments was measured on the first radiographs made after the affected upper extremity was placed in a brace. RESULTS: Sixty-three patients (80%) had documented healing of the fracture. Sixteen patients (20%) had motion at the fracture site and a persistent fracture line shown on radiographs six weeks or more after injury. In multivariable analysis, each millimeter of gap between the main fragments with the patient wearing the brace (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.1 to 1.7), smoking (OR = 5.8, 95% CI = 1.4 to 25), and female sex (OR = 5.3, 95% CI = 1.2 to 23) increased the risk of fracture instability six weeks after injury (R2 = 0.38, area under the receiver operating characteristic [ROC] curve = 0.81). CONCLUSIONS: The magnitude of the gap between the fracture fragments is an independent risk factor for fracture instability and the lack of a bridging callus six weeks after a diaphyseal humeral fracture. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Risk Factors for Fracture Mobility Six Weeks After Initiation of Brace Treatment of Mid-Diaphyseal Humeral Fractures

Neuhaus

Menendez

Kurylo³

et al. 2014

Journal of Bone and Joint Surgery

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“…Rutgers and Ring retrospectively reviewed treatment of diaphyseal humerus fractures that were treated with functional bracing and found proximal third long oblique fractures may be at greater risk of nonunion (39 % in their study), they attribute this to the pull of the deltoid on the distal aspect of the proximal fragment and muscle interposition [9]. Toivanen et al also noted that over half of the fractures of the proximal third of the humerus in their study treated with functional bracing also went on to nonunion [17].…”

Section: Current Concepts In Nonoperative Versus Operative Interventionmentioning

confidence: 99%

Humeral shaft fractures

Spiguel

Steffner

2012

Curr Rev Musculoskelet Med

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Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

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“…Most of the fractures can be effectively treated conservatively [1,2]. Operative intervention is indicated in special circumstances including (1) failure of closed reduction, (2) intra-articular extension of fractures, (3) neurovascular compromises, (4) associated ipsilateral forearm and elbow fractures, (5) segmental fractures, (6) pathological fractures, (7) open fractures, (8) fractures in polytraumatised patients, (9) bilateral humeral shaft fractures, (10) periprosthetic fractures and (11) transverse or short oblique fractures [3].…”

Section: Introductionmentioning

confidence: 99%

Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique

Zeng

et al. 2009

International Orthopaedics (SICOT)

125

111

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Results of two methods, conventional open reduction-internal plating and minimally invasive plating osteosynthesis (MIPO), in the treatment of mid-distal humeral shaft fractures were compared. Thirty-three patients were retrospectively analysed and divided into two groups. Group A (n=17) patients were treated by MIPO and group B (n=16) by conventional plating. The mean operation time in group A was 92.35±57.68 minutes and 103.12±31.08 minutes in group B (P=0.513). Iatrogenic radial nerve palsy in group A was 0% (0/17) and 31.3% in group B (5/16 (P=0.012). The mean fracture union time in group A was 15.29±4.01 weeks (range 8-24 weeks), and 21.25±13.67 weeks (range 10-58 weeks) in group B (P=0.095). The mean UCLA end-result score in group A was 34.76±0.56 points (range 33-35), and 34.38± 1.41 points (range 30-35) in group B (P=0.299). The mean MEPI in group A was 99.41±2.43 points (range 90-100) and 99.69±1.25 points (range 95-100) in group B (P= 0.687). When compared to the conventional plating techniques, MIPO offers advantages in terms of reduced incidence of iatrogenic radial nerve palsies and accelerated fracture union and a similar functional outcome with respect to shoulder and elbow function.

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Functional treatment of closed humeral shaft fractures

Cited by 114 publications

References 19 publications

Risk Factors for Fracture Mobility Six Weeks After Initiation of Brace Treatment of Mid-Diaphyseal Humeral Fractures

Risk Factors for Fracture Mobility Six Weeks After Initiation of Brace Treatment of Mid-Diaphyseal Humeral Fractures

Humeral shaft fractures

Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique

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