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PubMed2004

Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation.

INTRODUCTION: Antegrade intramedullary (IM) nailing of humeral shaft fractures is reported to cause shoulder joint impairment. This retrospective study compared shoulder joint symptoms, range of motion (ROM), and isometric strength after antegrade IM nailing and dynamic compression (DC) plating of humeral shaft fractures. MATERIALS AND METHODS: We compared 29 patients with DC plating and 44 with antegrade IM nailing of their humeral shaft fractures. Shoulder pain, L'Insalata and Constant scores, shoulder joint ROM and isometric shoulder strengths were measured after mean follow-up of 6.2 (1-15) years (DC plating) and 5.5 (2-10) years (IM nailing). RESULTS: Patients had nonsignificantly more shoulder pain after IM nailing than after DC plating. Shoulder scores and isometric strength measurements showed no difference between the groups. Flexion was significantly better after DC plating, but none of the other ROM parameters differed between the groups. The shoulder scores and all ROM and strength parameters of the injured side were significantly lower than on the uninjured side in both groups. CONCLUSIONS: Shoulder joint ROM and strength does not recover to normal after humeral shaft fracture. Antegrade IM nailing if performed properly is not responsible for shoulder joint impairment.

Adolescent↗
PubMed1997

Short-term external support promotes healing in semirigidly fixed fractures.

The effect of different postoperative treatments on the healing of rabbit femoral shaft fractures fixed semirigidly by intramedullary nailing was investigated clinically, radiologically, and mechanically. A unilateral transverse midfemoral fracture was performed on all rabbits and was treated with an intramedullary nailing without previous reaming. When the operated limb was immobilized postoperatively by a splint with the knee in extension for 1 week (Group 2), nine of 10 fractures healed. When immobilized in extension for 7 weeks (Group 3), eight of 10 healed. When immobilized in flexion for 7 weeks (Group 4), five of 10 fractures were clinically healed within 7 weeks. When the limb was not immobilized by external support (Group 1), only one of 10 healed. The radiologic healing correlated with the clinical healing in each group. There were no statistically significant differences among the groups in the quantity of callus or in the biomechanical properties of the healed fractures. The results indicate that even a short term additional external support of the limb with the knee in extension was advantageous to the healing of femoral shaft fractures fixed semirigidly by intramedullary nailing.

Animals↗
PubMed1983

Use of the Hoffmann external fixator in the treatment of femoral fractures.

The Hoffmann external fixator has proved to be an effective means of stabilizing complex femoral fractures in patients in whom prolonged traction or internal fixation is not advisable. It provides for the prompt mobilization of multiple-trauma victims and assists in the evaluation of the "floating knee." Pin tract infections and lack of stability or adaptability of the frame are not major problems. Increased risks of delayed union or nonunion are often attributed to this mode of therapy. Within the limits of the present study these difficulties could not be directly related to the use of the fixator. In four patients nonunions were not unexpected and could have occurred with any form of therapy. Improved results may be achieved by earlier recognition of situations in which healing potential is compromised so that bone grafts may be applied at an early stage for prevention of nonunion.

Adolescent↗
PubMed1996

[A new method of osteosynthesis in proximal humeral fractures: a new internal fixation device. Apropos of 17 cases followed over more than 2 years].

PURPOSE OF THE STUDY: The authors describe a new internal fixation device, and report on 17 proximal humeral fractures managed with this technique. MATERIAL AND METHODS: The fracture patterns, using Neer's classification were: 9 displaced three-part fractures, 4 displaced four-part fractures and 4 interior fracture dislocations (mean age of the patients: 70 years). The device is a two-part titanium device. The humeral component has a long vertical stem cemented in the humeral shaft; and a short proximal portion set at an angle of 135 degrees on the stem, with a neck and a Morse taper cone. The other part is a crown-shaped stapple, whose base is a perforated disk with a central Morse taper socket. The rim of the crown has five prongs which, together with the central socket, are impacted in the cancellous bone of the humeral head. The taper of the humeral component is inserted into the central socket of the stapple to provide fracture fixation. Tuberosities are reattached to the shaft with non absorbable sutures. RESULTS: Mean follow-up was 29 months. The global ratings were as follows: 4 excellent results, 6 good results, 4 fair results, 3 poor results. Mean active forward flexion: 100 degrees, and mean active external rotation 22 degrees. After exclusion of the 4 fracture-dislocations, the global rating became: 4 excellent results, 5 good results, 3 fair results, 1 poor result. Mean active forward flexion: 110 degrees and mean active external rotation: 31.5 degrees. There were no case of avascular necrosis in 13 patients. Complications requiring surgery occurred in one case: an upper protrusion of the stapple which required replacement of the stapple by a prosthetic humeral head. Other complications included: 2 asymptomatic partial protrusions of the stapple, 2 complete and two partial avascular necrosis in fracture-dislocations. DISCUSSION: Except for the fracture-dislocations our device confers several major benefits. The humeral head is preserved. Typical problems associated with joint replacement (dislocations, loosening, glenoid degeneration) are avoided. Humeral head conservation enhances healing of the tuberosities. Fixation could always be obtained, regardless of the complexity of the fracture pattern. An hemiarthroplasty (e.g. in case of avascular necrosis) is possible by the modular design of the device.

Adult↗