DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20200741

A comparative study of operative dynamic compression plating versus non-operative management in fracture shaft of humerus

Naren Gaur, Naveen Kumar Singh

Abstract


Background: Fracture shaft of humerus is among injuries which is commonly seen in clinical practice and frequently seen in polytrauma. Humerus   shaft fractures account for 3% of all orthopedic injuries. Nonoperative treatment had been the mainstay of treatment for fracture shaft of humerus earlier. The association of conservative treatment with some morbidity, complications and prolonged immobilization leads to increase in various operative modalities of management. One of the commonly used operative modality is dynamic compression plating (DCP). In view of above considerations, a study was undertaken at our hospital which aimed to compare non-operative treatment with operative DCP for the management of fracture shaft of humerus. Aims and objectives of this study to compare the results of non-operative versus operative treatment of humerus shaft fracture.

Methods: It was a prospective comparative study. Total 40 patients were taken for this study. 20 patients for operative and 20 patients for non-operative. Functional outcome was measured by the DASH scoring. P<0.05 was considered statistically significant.

Results: Among the 40 patients 14 had excellent results, 12 had good, 8 had fair and 6 had poor results. Functional outcome scores were better for operative group as compared to non- operative group with p<0.0001.  

Conclusions: Dynamic compression plating of humerus is better method than conservative method because it achieves higher union rates.


Keywords


Fracture shaft humerus, Dynamic compression plate, Non-operative management, Comparative study

Full Text:

PDF

References


Zuckerman JD, Koval KJ. Rockwood CA, Green DP, Bucholz RW, Heckman JD. Fractures of the shaft of the humerus. In: Rockwood and Green’s Fractures in Adults. 4th Edition. Philadelphia: Lippincott-Raven 1996;1025-53.

Epps CH, Grant RE, Rockwood CA, Green DP, Bucholz RW. Fractures of the shaft of the humerus. In: Rockwood and Green’s Fractures in adults. 3rd ed. Philadelphia: Lippincott Williams & Williams 1991.

Tsai CH, Fong YC, Chen YH, Hsu CJ, Chang CH, Hsu HC. The epidemiology of traumatic humeral shaft fractures in Taiwan. Int Orthop 2009;33:463-7.

Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. Journal of Bone & Joint Surgery American Volume 2000;82(4):478–86

Allgower M, Perren S, Matter P. A new plate for Internal Fixation the Dynamic Compression Plate (DCP). Injury 1970; 2:40-47.

Perren SM, Berger RM, Steinemann S, Muller ME, Allgower M. A dynamic compression plates. Acta Orthop Scand 1969;125:31-41.

Foster RJ, Dixon GJ, Bach AW, Appleyard RW, Green TM. Internal fixation of fractures and non-unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surgery Am 1985;67:857-64.

Rogers J, Bennett J, Tullos H. Management of concomitant ipsilateral fractures of the humerus and forearm. J Bone Joint Surgery Am 1984;66:552-6.

Atroshi I, GummessonI, Andersson B, Dahlgr E, Johannson A. The Disability of the Arm, Shoulder and Hand (DASH) outcome questionnaire. Actaorthopsc 2000;71(6):613-18.

Stewart MJ, and Hundley JM. Fractures of the Humerus: A Comparative Study in Methods of Treatment. Journal of Bone and Joint Surgery 1955; 37(A):681.

Klenerman L. Fracture of the shaft the humerus. J. Bone Surgery 1966;48B:105-11.

Bell MJ, Beauchamp CG, Kellam JK, Mcmurtry RY. The Result of plating Humerus shaft fractures in patients with multiple injuries. The sunny brook experience. J Bone Joint Surg Br 1985;67-B:293-96.

Rosen. H. The treatment of non-union and pseudoarthrosis of the humerus shaft. Orthopaedic Clinics of North America 1990;21(4):725-42.

Healy WL, White GM, Mick CA, Brooker AF, Weiland AJ. Nonunion of the humeral shaft. ClinOrthop 1987;219:206-13.

Rubel I, Kloen P, Campbell D et al. Open Reduction and Internal Fixation of Humeral Non-Unions, A Biochemical and Clinical Study. J Bone Joint Surg (Am). 2002;84:1315-22.

Crenshaw AH. Fracture of humeral shaft with radial nerve palsy. In: Crenshaw AH, ed. Campbell’s operative orthopaedics. Eighth ed. St. Louis: Mosby Year Book. 1992;2:1016.

Koch PP, Gross DFL, Gerber C: The results of functional (Sarmiento) bracing of humeral shaft fractures, J Shoulder Elbow Surg. 2002;11:143.

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.

Jupiter JB. Complex non-union of the humeral diaphysis: treatment with a medial approach, an anterior plate and a vascularized fibular graft. J Bone Joint Surg. 1990;72(A):701-7.

Kolb DN, Knoefel WT, Schweiberer L. The treatment of humeral shaft fractures. Results of a prospective AO multicenter study. Unfallchirurg. 1991;94(9):447-54.