Comparison of Two Surgical Methods for the Management of Mid–Distal Humerus Fractures Not Involving the Joint (plate–screw osteosynthesis with elastic nail-supported external fixator application)
Abstract
Aim: The open reduction-plate method is frequently used in the surgical treatment of mid-distal humeral fractures. However, the radial nerve is always a major problem. In our study, we tried to present a surgical procedure that would eliminate this problem. For this reason, patients who were operated on for humeral mid-distal fractures in our hospital were investigated.
Methods: We compared the elastic nail-supported external fixator after closed reduction with plate-screw osteosynthesis after open reduction. Group 1 (16) was divided into elastic nail supported external fixator, Group 2 (39) plate screw osteosynthesis. Groups were analyzed retrospectively.
Results: While there was no delayed union and no neurological complications in group 1, three patients in group 2 had pseudoarthrosis and two patients had iatrogenic radial nerve deficit.
Conclusion: There was no significant difference in union times and complication rates. However, in the method we defined; operative time, length of hospital stay were statistically significantly lower. We have also demonstrated further advantages of the technique we have described. These; protection of fracture hematoma, no incision scar, no plaster fixation, early rehabilitation, ease of removal of implants. Its disadvantage is that the fixator stays on the patient for about three months. We think that the method will become widespread when the advantages and disadvantages of this technique are evaluated by surgeons. A monolateral external fixator supported by an elastic nail can be used safely, successfully, and easily for the treatment of mid–distal humerus fractures that do not involve the joint.
Supporting Institution
There was no financial support from public, commercial, or non-profit sources
Project Number
no
Thanks
Our article has been translated by 'Enago translation service'
References
- 1. Robinson CM, Hill RMF, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17:38-47.
- 2. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691-7.
- 3. Anglen J. Distal humerus fractures. J Am Acad Orthop Surg. 2005;13:291-7.
- 4. Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, Papagelopoulos PJ. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev. 2018;3:558-67.
- 5. Claessen FMAP, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg. 2015;24:307-11.
- 6. Schwab TR, Stillhard PF, Schibli S, Furrer M, Sommer C. Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome. Eur J Trauma Emerg Surg. 2018;44:235-43.
- 7. Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int. 2015;35:1015-20. 8. Korompilias AV, Lykissas MG, Kostas-Agnantis IP, Vekris MD, Soucacos PN, Beris AE. Approach to radial nerve palsy caused by humerus shaft fracture: is primary exploration necessary? Injury. 2013;44:323-6.
- 9. Cho H, Lee HY, Gil YC, Choi YR, Yang HJ. Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks. Clin Anat. 2013;26:862-9.
- 10. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000;82:478-86.
- 11. Wallny T, Westermann K, Sagebiel C, Reimer M, Wagner UA. Functional treatment of humeral shaft fractures: indications and results. J Orthop Trauma. 1997;11:283-7.
- 12. Kayser M, Muhr G, op den Winkel R, Ekkernkamp A. Functional treatment of humerus fractures by the Sarmiento method. Results after 3 years’ experience. Unfallchirurg. 1986;89:253-8.
- 13. Cebesoy O, Köse KÇ, Baltacı ET, Işık M, Akan B, Tip AKUA. A humerus Şaft Kırıklarında konservatif tedavi Sonuçlarımız. Kocatepe Tıp Derg. 2005;6:53-6.
- 14. Çift H, Seyhan B, Şahin A, Özkan K, Emre TY, Uzun M. Humerus cisim Kırıklarının Cerrahi Tedavisi. Kırıkkale Univ Tıp Fak Derg. 2008;10:19-22.
- 15. Huri G, Biçer ÖS, Öztürk H, Deveci MA, Tan I. Humerus şaft kırıklarında minimal invaziv perkütan plak osteosentezinin (MIPPO) fonksiyonel sonuçları: Klinik çalışma. Acta Orthop Traumatol Turc. 2014;48:406-12.
- 16. McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br. 2000;82:336-9.
- 17. Burg A, Berenstein M, Engel J, Luria T, Salai M, Dudkiewicz I, Velkes S. Fractures of the distal humerus in elderly patients treated with a ring fixator. Int Orthop. 2011;35:101-6.
- 18. Upadhyay AS, Lil NA. Use of titanium elastic nails in the adult diaphyseal humerus fractures. Malays Orthop J. 2017;11:53-9.
Eklemi İçermeyen Mid-Distal Humerus Kırıklarının Tedavisinde İki Cerrahi Yöntemin Karşılaştırılması (Elastik çivi destekli eksternal fiksatör uygulaması ile plak-vida osteosentezi)
Abstract
Amaç: Günümüzde humerus orta-distal kırıklarının cerrahi tedavisinde sıklıkla açık redüksiyon-plak yöntemi kullanılmaktadır. Ancak radial sinir her zaman büyük bir problem olarak karşımıza çıkmaktadır. Biz çalışmamızda, bu problemi ortadan kaldırcak bir cerrahi prosedür ortaya koymaya çalıştık. Bu nedenle hastanemizde humerus orta-distal kırığı nedeniyle ameliyat edilen hastalar araştırıldı.
Metod: Kapalı redüksiyon sonrası elastik nail destekli eksternal fiksatör ile açık redüksiyon sonrası plak-vida osteosentezini karşılaştırdık. Grup 1(16) elastik nail destekli eksternal fiksatör, Grup 2 (39) plak vida osteosentezi olarak ayrıldı. Gruplar retrospektif incelendi.
Sonuçlar: Grup 1’de kaynama gecikmesi ve nörolojik komplikasyon olmazken grup 2’de üç hastada psödoartroz, iki hastada iatrojenik radial sinir defisiti vardı. Grup dağılımları homojen olmadığından dolayı bu farklar istatistiksel olarak gösterilemedi.
Tartışma: Kaynama süreleri ve komplikasyon oranlarında anlamlı fark yoktu. Ancak tanımladığımız yöntemde; ameliyat süresi, hastanede yatış süresi istatistiksel açıdan anlamlı şekilde düşüktü. Tanımladığımız tekniğin başka avantajlarını da ortaya koyduk. Bunlar; kırık hematomunun boşalmaması, insizyon skarı olmaması, alçı tespiti yapılmaması, erken rehabilitasyon, implantların çıkarılmasının kolaylığıdır. Fiksatörün yaklaşık üç ay hasta üzerinde kalması ise dezavantajıdır . Bu tekniğin avantajları ve dezavantajları cerrahlar tarafından değerlendirildiğinde yöntemin yaygınlaşacağını düşünmekteyiz.
Project Number
no
References
- 1. Robinson CM, Hill RMF, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17:38-47.
- 2. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691-7.
- 3. Anglen J. Distal humerus fractures. J Am Acad Orthop Surg. 2005;13:291-7.
- 4. Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, Papagelopoulos PJ. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev. 2018;3:558-67.
- 5. Claessen FMAP, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg. 2015;24:307-11.
- 6. Schwab TR, Stillhard PF, Schibli S, Furrer M, Sommer C. Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome. Eur J Trauma Emerg Surg. 2018;44:235-43.
- 7. Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int. 2015;35:1015-20. 8. Korompilias AV, Lykissas MG, Kostas-Agnantis IP, Vekris MD, Soucacos PN, Beris AE. Approach to radial nerve palsy caused by humerus shaft fracture: is primary exploration necessary? Injury. 2013;44:323-6.
- 9. Cho H, Lee HY, Gil YC, Choi YR, Yang HJ. Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks. Clin Anat. 2013;26:862-9.
- 10. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000;82:478-86.
- 11. Wallny T, Westermann K, Sagebiel C, Reimer M, Wagner UA. Functional treatment of humeral shaft fractures: indications and results. J Orthop Trauma. 1997;11:283-7.
- 12. Kayser M, Muhr G, op den Winkel R, Ekkernkamp A. Functional treatment of humerus fractures by the Sarmiento method. Results after 3 years’ experience. Unfallchirurg. 1986;89:253-8.
- 13. Cebesoy O, Köse KÇ, Baltacı ET, Işık M, Akan B, Tip AKUA. A humerus Şaft Kırıklarında konservatif tedavi Sonuçlarımız. Kocatepe Tıp Derg. 2005;6:53-6.
- 14. Çift H, Seyhan B, Şahin A, Özkan K, Emre TY, Uzun M. Humerus cisim Kırıklarının Cerrahi Tedavisi. Kırıkkale Univ Tıp Fak Derg. 2008;10:19-22.
- 15. Huri G, Biçer ÖS, Öztürk H, Deveci MA, Tan I. Humerus şaft kırıklarında minimal invaziv perkütan plak osteosentezinin (MIPPO) fonksiyonel sonuçları: Klinik çalışma. Acta Orthop Traumatol Turc. 2014;48:406-12.
- 16. McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br. 2000;82:336-9.
- 17. Burg A, Berenstein M, Engel J, Luria T, Salai M, Dudkiewicz I, Velkes S. Fractures of the distal humerus in elderly patients treated with a ring fixator. Int Orthop. 2011;35:101-6.
- 18. Upadhyay AS, Lil NA. Use of titanium elastic nails in the adult diaphyseal humerus fractures. Malays Orthop J. 2017;11:53-9.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Articles |
| Authors | |
| Project Number | no |
| Publication Date | April 30, 2023 |
| Acceptance Date | April 19, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 1 |
