DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20181795

Functional outcome of middle third humeral shaft fractures treated with anteromedial plate osteosynthesis through an anterolateral approach

Sandeep Kubsad, Suresh B., Bharath S. G., Manohar Reddy, Harish S. Pai

Abstract


Background: The main aim of treatment of the humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. Plate osteosynthesis remains the standard of surgical treatment displaced middle third humeral fractures. The most commonly used approaches for treating these fractures are posterior and anterolateral, but these approaches can have iatrogenic radial nerve injury. Our aim is to study the incidence of radial nerve palsy and functional outcome of anterolateral approach with anteromedial plating.

Methods: A total of 26 patients in the age group of 21 to 62 years were included in this prospective study, who were treated by anteromedial plating through anterolateral approach for humerus shaft. Functional assessment was done using Rodriguez-Merchan criteria.

Results: 26 patients with shaft humerus fracture were included in the study with 19 (73%) patients were less than 40 years age. Most common type of fracture pattern is A3 type and the mean duration of surgical time was 60±10 min for anteromedial plating. The time taken for the fracture union was less than 4 months in the most patients (88%). There was no evidence of iatrogenic radial nerve injury. Functional assessment done using Rodriguez-Merchan criteria showed 84.6% of the patients had good to excellent functional outcome.

Conclusions: For treatment of displaced middle third humeral fractures open reduction with anteromedial plating through anterolateral approach is surgically safer and gives better functional outcome.

 


Keywords


Middle third humeral fractures, Anterolateral approach, Anteromedial plating, Plate osteosynthesis, Iatrogenic radial nerve injury

Full Text:

PDF

References


Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br. 2006;88:1469‑73.

Livani B, Belangero W, Medina G, Pimenta C, Zogaib R, Mongon M. Anterior Plating as a Surgical Alternative in the Treatment of Humeral Shaft Non-Union. Int Orthop. 2010;34:1025-31.

Kirin I, Jurisic D, Grebic D, Nadalin S. The advantages of humeral anteromedial plate osteosynthesis in the middle third shaft fractures. Middleast J Med. 2011;123(3-4):83-7.

Walker M, Palumbo B, Brooks J, Gelderen JV, Mighell M. Humeral shaft fractures:a review. J Shoulder Elbow Surg. 2011;20(5):833-44.

Denies E, Nijs S, Sermon A, Broos P. Operative Treatment of Humeral Shaft Fractures. Comparison of Plating and Intramedullary Nailing. Acta Orthopaedica Belgica. 2010;76;735-42.

Boschi V, Pogorelic Z, Gulan G, Vilovic K, Stalekar H, Bilan K, et al. Subbrachial Approach to Humeral Shaft Fractures: New Surgical Technique and Retrospective Case Series Study. Canadian J Surg. 2013;56:27-34.

Henry Gray (1825–1861). Anatomy of the Human Body. 1918.

Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P. Rockwood & Green's Fractures in adults, 6th Edition; 1918: 1119.

Ricci FP, Barbosa RI, Elui VM, Barbieri CH, Mazzer N, Fonseca Mde C. Radial nerve injury associated with humeral shaft fracture:A retrospective study. Acta Ortop Bras. 2015;23:19‑21.

Zheng YF, Zhou JL, Wang XH, Shan L, Liu Y. Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures. Chin Med J. 2016;129:1850‑5.

Judet R, Patel A, Demeulenaere C. 3 approaches to the upper part of the humerus and the humeral diaphysis. Presse Med. 1968;76(41):1961–3.

Böstman O, Bakalim G, Vainionpää S, Wilppula E, Pätiälä H, Rokkanen P. Immediate radial nerve palsy complicating fracture of the shaft of the humerus:when is early exploration justified? Injury. 1985;16(7):499–501

Senthil L, Jambu N, Chittranjan BS. Anteromedial Plating of Humerus—An Easier and Effective Approach. Open J Orthop. 2015;5:305-10.

Mattam S, Rafi M, Goud HK, RangaRao KRP, Gubbi SS. Medial plating of humerus shaft fractures through anterolateral approach. IOSR J Dental Med Sci. 2017;16(4):18-23

Kumar BS, Soraganvi P, Satyarup D. Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach. Malaysian Orthop J. 2016;2016:1.