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ORIGINAL ARTICLE
Year : 2012  |  Volume : 39  |  Issue : 3  |  Page : 114-117

Study of functional outcome of humerus shaft fracture in adults treated with dynamic compression plating


Department of Orthopaedics, KLE University's JN Medical College and Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India

Date of Web Publication11-Jan-2013

Correspondence Address:
Sameer M Haveri
H.No. 2, Second Cross, Veerbhadra Nagar, Belgaum - 590 016, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.105912

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  Abstract 

Background and Objectives: Fractures of humeral shaft account for approximately 3-5% of all fractures. Most will heal with appropriate conservative care, although a small but consistent number will require surgery for optimal outcome. The aim of this study is to assess the results of humeral shaft fractures with dynamic compression plate (DCP). Materials and Methods: This is a prospective study of 35 cases of fracture shaft of humerus admitted to Bapuji Hospital and C.G. Hospital attached to J.J.M. Medical College, Davangere, between October 2005 and September 2007. Cases were taken according to inclusion and exclusion criteria. Results: In our series of 35 cases, there were 31 men and 4 women, with average age of 42.5 years. Twenty-six (74%) cases were admitted due to road traffic accident and with slight predominance of left side. Of 35 cases, 4 (11%) were proximal third, 28 (80%) were middle third, and 3 (9%) were distal third. Transverse or short oblique fractures were most common, that is, 18 (51%) patients. Eleven (31%) cases were having associated injuries. The fractures united in 33 (94%) patients with 2 (6%) cases going for nonunion due to deep infection in one, in other case may be due to immediate weight-bearing activity done by the patient. There was one (3%) case of delayed union, which united after six months. Good or full range of mobility of shoulder and elbow joints was present in 32 (91%) patients with 3 (9%) patients having stiffness of shoulder and elbow joint. Conclusion: Internal fixation of the humerus with DCP achieves higher union rates and comparable better results as compared with other modes of treatment.

Keywords: Dynamic compression plate, delayed union, fractures, humeral shaft, nonunion, short oblique, transverse


How to cite this article:
Haveri SM, Maheswarappa D. Study of functional outcome of humerus shaft fracture in adults treated with dynamic compression plating. J Sci Soc 2012;39:114-7

How to cite this URL:
Haveri SM, Maheswarappa D. Study of functional outcome of humerus shaft fracture in adults treated with dynamic compression plating. J Sci Soc [serial online] 2012 [cited 2019 Jul 20];39:114-7. Available from: http://www.jscisociety.com/text.asp?2012/39/3/114/105912


  Introduction Top


Fractures of humeral shaft account for approximately 3-5% of all fractures. Most will heal with appropriate conservative care, although a small but consistent number will require surgery for optimal outcome. [1] The aim of this study is to assess the results of humeral shaft fractures with dynamic compression plate (DCP).


  Patients and Methods Top


It is a prospective study which was carried out from October 2005 to September 2007 in Chigateri General Hospital and Bapuji Hospital attached to J.J.M. Medical College, Davangere, Karnataka State, India. In this study period, 35 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using DCP. Exclusion criteria were grade 3 open fractures, nonunion, delayed union, and pathological fractures. Preoperative evaluation was done as history, examination, standard radiographs of the humerus, i.e., anteroposterior and lateral views, were obtained. The shoulder and elbow joints were included in each view. The limb was immobilized in a U-slab with sling. Injectable analgesics were given. Routine investigations were done, and informed consent and physician reference for fitness were obtained.

Procedure

Anterolateral approach with lateral plating was the most preferred surgical approach. Posterior approach was used in two cases due to the fracture being in the distal third. A broad 4.5-mm DCP made of 316L stainless steel was used, and a minimum of six cortices were engaged with screw fixation in each fragment. Standard surgical procedure was followed.

Follow-up

Immediate range of motion exercises of shoulder and elbow was started. No external splint was given. All the patients were followed up at monthly intervals for the first 3 months, two monthly intervals till fracture union, and once in six months till the completion of study.


  Results Top


A total of 35 patients were present. Mean age of patients was 42.5 years (range: 18-65 years). Thirty-one patients were men and 4 were women. Left side was affected in 19 patients (54%) and right side was affected in 16 patients(46%). Most common mode of injury was road traffic accidents in 26 patients (74%), fall in 6 patients (17%), accident at work place in 2 patients (6%), and assault in one patient (3%). Of the 35 patients, 11 (31%) patients have associated injuries. Majority of the fractures were in the middle third (28 in number, i.e., 80%).

Fracture pattern

Transverse or short oblique in 18 patients (51%), comminuted in 13 patients (37%), long oblique in 4 patients (12%), and no segmental fractures. General anesthesia was given for all the cases. The anterolateral approach of Henry was used in all cases except in two cases in which the posterior approach was used due to the fracture being distal. Tourniquet was not used in any of our cases, as it comes in the way of surgery so. The follow-up ranged from 6 months to 16 months.

Duration of fracture union

Sound union in 32 (91%) patients is less than 6 months, delayed union in 1 (3%) patient, nonunion in 2 (6%) patients - one due to deep infection and in another it may be due to early weight-bearing activity by the patient.

Range of mobility of the shoulder and elbow joints

Twenty eight (80%) patients recovered full range of mobility (ROM) of shoulder and elbow joint. Four (11%) patients recovered good ROM (within 10-15% of full range). Three (9%) patients had poor ROM and of these, 1 (3%) patient had a head injury with wrist drop, 1 (3%) patient had a deep infection causing nonunion and the reason for stiffness in 1 (4%) patient was not clear. The American shoulder and elbow surgeons (ASES) [2],[3] shoulder score is for 13 activities of daily living requiring full shoulder and elbow movement. The maximum possible score is 52 points. The average ASES score obtained was 48. Complications in our study are shown in [Table 1]. Results were according to Romen, et al., scoring: Excellent results in 28 (80%) patients, good results in 4 (11%) patients, and poor resultsin 3 (9%) patients [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5].
Figure 1: Preoperative radiographs

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Figure 2: X-ray showing complete union

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Figure 3: Range of motion in elbow and shoulder

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Figure 4: Range of motion in elbow and shoulder

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Figure 5: Range of motion in elbow and shoulder

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Table 1: Complications seen in our study


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  Discussion Top


In our study, the fractures united in 33 (94%) patients with 2 (6%) cases going for nonunion due to deep infection in one and in other case it may be due to immediate weight-bearing activity done by the patient. There was one (3%) case of delayed union, which united after six months. Good or full range of mobility of shoulder and elbow joints was present in 32 (91%) patients with 3 (9%) patients having stiffness of shoulder and elbow joint.

Open reduction with plate fixation usually ensures a high likelihood of anatomic reduction, radial nerve exploration, and ideal in patients with narrow medullary canal. [4] Disadvantages of plating are extensive dissection with greater disruption of the soft-tissue envelope, risk of infection, potential injury to the radial nerve (5%), poor fixation in osteoporotic bone with DCP, and the possible need for plate removal at a later date. [5],[6],[ 7] The higher percentage of stiffness in this series, as compared with studies done by McCormack et al., [3] is an indication of the importance of patient education and physiotherapy during postoperative management. According to various studies, nonunion rate ranges from 1-9% with plating. [3],[5],[8] Results of other studies with plating are compared with our study in [Table 2].
Table 2: Various studies showing their results


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  Conclusion Top


Strict adherence to the arbeitsgiminschaft steosynthesifragens (AO) principles during fixation, meticulous attention to maintenance of asepsis during surgery, patient education, and a well-planned rehabilitation program are required to obtain better results. If these principles are adhered to DCP fixation of humerus shaft fractures, it results in fewer complications and greater patient satisfaction. According to various randomized controlled trial (RCT)/meta-analysis [3],[9],[10],[11],[12] and our studies, plating is still the gold standard for fracture shaft humerus. Nailing is indicated in specific situations such as pathological fractures and segmental fractures. [2]

 
  References Top

1.Mckee MD, Larson S. Humeral shaft fractures. Rockwood and Green's Fractures in Adults. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2010. p. 999-1038.  Back to cited text no. 1
    
2.Lin J, Shen PW, Hou SM. Complications of locked nailing in humeral shaft fractures. J Trauma 2003;54:943-9.  Back to cited text no. 2
    
3.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.  Back to cited text no. 3
    
4.Riemer BL, Foglesong ME, Burke CJ 3 rd , Butterfield SL. Complications of seidel intramedullary nailing of narrow diameter humeral diaphyseal fractures. Orthopedics 1994;17:19-29.  Back to cited text no. 4
    
5.Heim D, Herkert F, Hess P, Regazzoni P. Surgical treatment of humeral shaft fractures-the basel experience. J Trauma 1993;35:226-32.  Back to cited text no. 5
    
6.An Z, He X, Zeng B. A comparative study on open reduction and plating osteosynthesis and minimal invasive plating osteosynthesis in treating mid-distal humeral shaft fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009;23:41-4.  Back to cited text no. 6
    
7.Jiang R, Luo CF, Zeng BF, Mei GH. Minimally invasive plating for complex humeral shaft fractures. Arch Orthop Trauma Surg 2007;127:531-5.  Back to cited text no. 7
    
8.Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated fractures of the humeral shaft. J Trauma 2000;49:278-80.  Back to cited text no. 8
    
9.Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: A prospective comparative study. Int Orthop 2010;34:571-6.  Back to cited text no. 9
    
10.Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop 2007;31:391-5.  Back to cited text no. 10
    
11.Putti AB, Uppin RB, Putti BB. Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong) 2009;17:139-41.  Back to cited text no. 11
    
12.Heineman DJ, Poolman RW, Nork SE, Ponsen KJ, Bhandari M. Plate fixation or intramedullary fixation of humeral shaft fractures. Acta Orthop 2010;81:2010;81:216-23.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Patients and Methods
Results
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