Comparative study between posterior and modified posterior approaches of humeral diaphyseal fractures in adults

Nagib, Emad Girgis; Shaker, Ahmed Saleh; Salama, Wael Adel; Eldosoky, Ahmed I.; Musa, Shazly Saleh

doi:10.21608/smj.2018.41805

Comparative study between posterior and modified posterior approaches of humeral diaphyseal fractures in adults

Document Type : Original Article

Authors

¹ Department of Orthopaedic and Traumatology , Faculty of Medicine , Sohag Univeristy.

² Department of Orthpaedic and Traumatology , Faculty of Medicine, Sohag University.

³ Department of Orthopedics and Traumatology, Faculty of medicine, Sohag university, Egypt.

10.21608/smj.2018.41805

Abstract

Introduction The optimal treatment of humeral shaft fractures continues to be debated. In the current investigation, we sought to determine the clinical and radiographic outcomes following the plate fixation of humeral shaft fractures utilizing the modified posterior approach.
Materials and methods A retrospective review identified a consecutive series of 30 humeral shaft fractures (OTA20-A, 10-B, or 0-C) treated with plate fixation via a posterior (14 patients), ormodified posterior approach (16 patients) between 2016 and 2017 by a single surgeon. Demographics, operative reports, clinical follow-up, and preoperative radiographs were reviewed. Postoperative radiographs were assessed for angular deformity and time to union. Range of motion and strength testing were also reviewed. Results A total of 30 humeral shaft fractures were reviewed with a mean clinical follow-up of 4 months. The mean time to union was13.1 weeks and there3 patients developed radial nerve palsies in posterior approach group and one case in modified posterior approach postoperatively.
Conclusionboth approaches could be used in the management of humeral diaphyseal middle or distal third fractures, And the modified posterior approach confirmed by our results minimizes the complication rate, allow early return of full range of elbow motion and full triceps muscle power and facilitates early return to normal activities of the patient with excellent functional out comes .

References

1 - Handbook of fractures, Kennethv A.Egol, Kenneth J. Koval and Joseph D.Zuckerman, fractures of the shaft of the humerus fourth edition Page 203:213, 1996

2 - Caldwell: The treatment of humeral fractures with Hanging cast Orthop. Trauma,10:16-13,1940.

3 - Epps Ch. Jr., Grant RE: Fractures of the shaft of the humerus .Chapter11 in fractures in adults, 3rd edition. Editors: Rockwood CA., Green DP, and Bucholz RW.

4 - Elizabeth B. Gausden, Alexander B.Christ ,Stephen J. Warner, et al The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications., Arc Orthop Trauma Surg 136:1683–1689 (2016

5- Muller ME,Allgower A, Scneider R,Willnegger H: Manual of internal fixation: techniques recommended by the AO-ASIF group.3rd edition.Berlin,Springer-Verlag,1991

6- MICHELLE GERWIN, ROBERT N. HOTCHKISS and ANDREW J. WEILAND.: Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis. With Reference to the Radial Nerve, J Bone Joint Surg Am78:1690-5,

7- Stanley Hoppenfeld, Piet deBoer et al, Surgical exposures in orthopedics, Fourth edition P 98 – 105

8- Yi JW, Oh JK, Han SB, Shin SJ, Oh CW, Yoon YC (2013) Healing process after rigid plate fixation of humeral shaft fractures revisited. Arch Orthop Trauma Surg 133:811–817

9-Wang X, Zhang P, Zhou Y, Zhu C (2014) Secondary radial nervepalsy after internal fixation of humeral shaft fractures. Eur JOrthop Surg Traumatol 24:331–333.

10-Yin P, Zhang L, Mao Z, Zhao Y, Zhang Q, Tao S, Liang X, Zhang H, Lv H, Li T, Tang P (2014) Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures. Injury 45:1121–1125.

11-Singh AK, Narsaria N, Seth RR, Garg S (2014) Plate osteosynthesis of fractures of the shaft of the humerus: comparison of limited contact dynamic compression plates and locking compression plates. J Orthop Traumatol 15:117–122.

12-Wang C, Li J, Li Y, Dai G, Wang M (2015) Is minimally invasive plating osteosynthesis for humeral shaft fracture advantageous compared with the conventional open technique? J Shoulder Elb Surg 24:1741–1748.