Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation.
Adult
Aged
Aged, 80 and over
Bone Plates
Female
Follow-Up Studies
Fracture Fixation, Internal
/ adverse effects
Fracture Healing
Humans
Humeral Fractures
/ diagnostic imaging
Male
Middle Aged
Open Fracture Reduction
/ adverse effects
Postoperative Complications
/ epidemiology
Radiography
Reoperation
/ statistics & numerical data
Retrospective Studies
Treatment Outcome
Young Adult
Anterior plating
Humeral shaft
Humerus
ORIF
Plate fixation
Posterior plating
Radial palsy
Trauma
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
10 Nov 2019
10 Nov 2019
Historique:
received:
26
05
2019
accepted:
10
10
2019
entrez:
12
11
2019
pubmed:
12
11
2019
medline:
31
3
2020
Statut:
epublish
Résumé
Fractures of the humeral shaft represent 2-4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications. We conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery. Between 2006 and 2014, 58 patients (mean age, 59.9; range, 19-97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented. Open reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.
Sections du résumé
BACKGROUND
BACKGROUND
Fractures of the humeral shaft represent 2-4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications.
METHODS
METHODS
We conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery.
RESULTS
RESULTS
Between 2006 and 2014, 58 patients (mean age, 59.9; range, 19-97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented.
CONCLUSIONS
CONCLUSIONS
Open reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.
Identifiants
pubmed: 31707990
doi: 10.1186/s12891-019-2888-2
pii: 10.1186/s12891-019-2888-2
pmc: PMC6844056
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
527Subventions
Organisme : Medizinische Fakultät, Ruhr-Universität Bochum
ID : IN-1214264
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