Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Ku, Ki-Hyeok; Baek, Jong-Hun; Kim, Myung Seo

doi:10.3390/jcm11102679

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…Tsai et al 50 found that sex was not associated with fracture healing. Ku et al 51 analyzed the risk factors for non-union in patients with distal humeral fractures after open reduction and internal fixation and found that BMI was not a statistically significant factor, a finding that is consistent with the results of this study. Cheng et al 52 confirmed that serum albumin level affects fracture healing; however, we did not obtain similar results after including it.…”

Section: Discussionsupporting

confidence: 90%

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Li,

Wang,

Zhou

et al. 2024

Sci Rep

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Closed femoral shaft fracture is caused by high-energy injuries, and non-union exists after operation, which can significantly damage patients’ body and mind. This study aimed to explore the factors influencing postoperative non-union of closed femoral shaft fractures and establish a predictive nomogram. Patients with closed femoral shaft fractures treated at Hebei Medical University Third Hospital between January 2015 and December 2021 were retrospectively enrolled. A total of 729 patients met the inclusion criteria; of them, those treated in 2015–2019 comprised the training cohort (n = 617), while those treated in 2020–2021 comprised the external validation cohort (n = 112). According to multivariate logistic regression analysis, complex fractures, bone defects, smoking, and postoperative infection were independent risk factors. Based on the factors, a predictive nomogram was constructed and validated. The C-indices in training and external validation cohorts were 0.818 and 0.781, respectively; and the C-index of internal validation via bootstrap resampling was 0.804. The Hosmer–Lemeshow test showed good fit of the nomogram (P > 0.05) consistent with the calibration plot results. The clinical effectiveness was best at a threshold probability of 0.10–0.40 in decision curve analysis. The risk prediction for patients with fractures using this nomogram may aid targeted prevention and rehabilitation programs.

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Section: Discussionsupporting

confidence: 90%

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Li,

Wang,

Zhou

et al. 2024

Sci Rep

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“…After distal humerus injury, there was a large number of local bone defect, and there was a risk of delayed or even non-union (31,32). Some studies have shown that the delay fracture recovery rate could reach 2%-10% after ORIF (33).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of anterior transposition of the ulnar nerve for distal humerus fractures: A systematic review and meta-analysis

Yan²,

Ren³

et al. 2023

Front. Surg.

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BackgroundThis systematic review and meta-analysis was performed to summarize available evidence of anterior transposition of the ulnar nerve for patients with distal humerus fractures.Materials and MethodsThe databases were searched from PubMed, Cochrane, Embase, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to June 2022. The clinical outcome included operation time, fracture healing time, hospital stays, elbow joint function, and ulnar neuritis rate. Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration).ResultsA total of 17 studies were included (8 RCTs and 9 retrospective studies), and 1280 patients were analyzed. The results of this meta-analysis showed anterior transposition group had longer operation time (MD = 20.35 min, 95%CI: 12.56–28.14, P < 0.00001). There was no significant difference in fracture healing time (SMD = −0.50, 95%CI: −1.50–0.50, P = 0.33), hospital stays (MD = −1.23 days, 95%CI: −2.72–−0.27, P = 0.11), blood loss (MD = 2.66 ml, 95%CI: −2.45–7.76, P = 0.31), and ulnar neuritis rate (OR = 1.23, 95%CI: 0.63–2.42, P = 0.54) between two groups. Finally, elbow joint motion, elbow joint function, fracture nonunion, and post-operative infection (P > 0.05) between two groups were not significantly statistic difference.ConclusionThis meta-analysis showed that anterior transposition group is not superior to non-transposition group for patients with distal humerus fractures without ulnar nerve injury. On the contrary, non-transposition group have shorter operation time than that of anterior transposition group. Non-transposition group did not increase the post-operative ulnar neuritis rate. Therefore, both anterior transposition group and non- transposition group are the treatment options for patients with distal humerus fractures without ulnar nerve injury. Besides, these findings need to be further verified by multi-center, double-blind, and large sample RCTs.

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“…It is known, however, that stabilization should provide stable-enough fixation to obtain a union. It also should allow for an early rehabilitation process, as movement is essential for success in the final treatment due to the fact that the elbow is intolerant to immobilization [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

Kruszewski,

Piszczatowski,

Piekarczyk

et al. 2024

JCM

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Background: Multi-comminuted, intra-articular fractures of the distal humerus still pose a challenge to modern orthopedics due to unsatisfactory treatment results and a high percentage (over 50%) of postoperative complications. When surgical treatment is chosen, such fractures are fixed using two plates with locking screws, which can be used in three spatial configurations: either parallel or one of two perpendicular variants (posterolateral and posteromedial). The evaluation of the fracture healing conditions for these plate configurations is unambiguous. The contradictions between the conclusions of biomechanical studies and clinical observations were the motivation to undertake a more in-depth biomechanical analysis aiming to indicate the weak points of two-plate fracture stabilization. Methods: Research was conducted using the finite element method based on an experimentally validated model. Three variants of distal humerus fracture (Y, λ, and H) were fixed using three different plate configurations (parallel, posterolateral, and posteromedial), and they were analyzed under six loading conditions, covering the whole range of flexion in the elbow joint (0–145°). A joint reaction force equal to 150 N was assumed, which corresponds with holding a weight of 1 kg in the hand. The biomechanical conditions of bone union were assessed based on the interfragmentary movement (IFM) and using criteria formulated by Steiner et al. Results: The IFMs were established for particular regions of all of the analyzed types of fracture, with distinction to the normal and tangential components. In general, the tangential component of IFM was greater than normal. A strong influence of the elbow joint’s angular position on the IFM was observed, with excessive values occurring for flexion angles greater than 90°. In most cases, the smallest IFM values were obtained for the parallel plaiting, while the greatest values were obtained for the posteromedial plating. Based on IFM values, fracture healing conditions in particular cases (fracture type, plate configuration, loading condition, and fracture gap localization) were classified into one of four groups: optimal bone union (OPT), probable union (PU), probable non-union (PNU), and non-union (NU). Conclusions: No plating configuration is able to ensure distal humerus fracture union when the full elbow flexion is allowed while holding a weight of 1 kg in the hand. However, flexion in the range of 0–90° with such loadings is acceptable when using parallel plating, which is a positive finding in the context of the early rehabilitation process. In general, parallel plating ensures better conditions for fracture healing than perpendicular plate configurations, especially the posteromedial version.

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Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Cited by 10 publications

References 24 publications

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Efficacy and safety of anterior transposition of the ulnar nerve for distal humerus fractures: A systematic review and meta-analysis

Weak Points of Double-Plate Stabilization Used in the Treatment of Distal Humerus Fracture through Finite Element Analysis

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