BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional ou...BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.展开更多
BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation o...BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.展开更多
Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical...Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical treatment in Mianyang Orthopedic Hospital between June 2010 and October 2015 were enrolled and randomly divided into MIPO group and ORIF group who were treated with minimally invasive plate oateosynthesis and open reduction internal fixation respectively. Before surgery as well as 1 d and 3 d after surgery, serum was collected to determine the contents of stress response molecules and bone metabolism markers.Results:1 d and 3 d after surgery, serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of both groups were higher than those before surgery while bone formation markers BGP, BALP, PINP and OPG contents were lower than those before surgery;serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of MIPO group were lower than those of ORFI group while bone formation markers BGP, BALP, PINP and OPG contents were higher than those of ORFI group.Conclusion: Compared with ORIF, MIPO for middle humeral shaft fractures can reduce stress response degree and improve bone metabolism.展开更多
Background： Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties ofanteromedial, ...Background： Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties ofanteromedial, anterolateral, and posterior plating for humeral shaft fractures. Methods： A distal third humeral shaft fracture model was constructed using fourth-generation sawbones （#3404, composite bone）. A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups： A, B, and C （n = 8 in each group） for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior （AP） and mediolateral （ML） directions and horizontal torsional destructive tests. Results： In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C （P 〈 0.05）. In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 ram, 0.13 ram, and 0.20 mm. Group B was smaller than Group C （P 〈 0.05）. In ML lbur-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 ram, and 0.17 ram. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05. and 16.83 N·m, respectively. Conclusions： Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group. We can suggest that anteromedial plating is a clinically safe and effective way for humeral shaft fractures.展开更多
Background： Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. Methods：...Background： Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. Methods： This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Results： Out of 78 patients, 69 patients underwent union in 90-150 days with a mean of I 10.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing joint movements and implant thilure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. ConcLusions： The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation ofosteoporotic and pathologic fractures.展开更多
目的:探讨两种微创钢板内固定术(minimally invasive plate osteosynthesis,MIPO)治疗肱骨干近端骨折的临床效果。方法:选取2020年6月—2022年6月瓮安县人民医院收治的82例肱骨干近端骨折患者为研究对象。按随机数表法将患者分为两组,...目的:探讨两种微创钢板内固定术(minimally invasive plate osteosynthesis,MIPO)治疗肱骨干近端骨折的临床效果。方法:选取2020年6月—2022年6月瓮安县人民医院收治的82例肱骨干近端骨折患者为研究对象。按随机数表法将患者分为两组,各41例。对照组行肱骨外侧入路MIPO术治疗,观察组行螺旋MIPO术治疗。比较两组手术情况、疼痛评分、肩关节功能、肩关节活动度及并发症发生情况。结果:观察组手术时间较对照组长,骨折愈合时间较对照组早,差异有统计学意义(P<0.05)。两组术后1 d、3 d、7 d的视觉模拟评分法(visual analogue scale,VAS)评分相比,差异无统计学意义(P>0.05)。两组术后Constant肩关节评分、美国肩与肘外科协会评分系统(American Shoulder and Elbow Surgeon'form,ASES)评分、美国加州大学肩关节评分系统(the University of California at Los Angeles shoulder rating scale,UCLA)评分高于术前,差异有统计学意义(P<0.05);两组术后Constant肩关节评分、ASES评分、UCLA评分相比,差异无统计学意义(P>0.05)。两组术后肩关节前屈、外旋活动度均高于术前,差异有统计学意义(P<0.05);两组术后肩关节前屈、外旋活动度相比,差异无统计学意义(P>0.05)。观察组并发症发生率较对照组低,差异有统计学意义(P<0.05)。结论:两种MIPO治疗肱骨干近端骨折均可取得较好效果,可加快肩关节功能恢复,而螺旋MIPO术骨折愈合更快,术后并发症更少。展开更多
基金Supported by Natural Science Foundation of Chongqing,China,No.CSTB2023NSCQ-MSX1080.
文摘BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
文摘BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.
文摘Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical treatment in Mianyang Orthopedic Hospital between June 2010 and October 2015 were enrolled and randomly divided into MIPO group and ORIF group who were treated with minimally invasive plate oateosynthesis and open reduction internal fixation respectively. Before surgery as well as 1 d and 3 d after surgery, serum was collected to determine the contents of stress response molecules and bone metabolism markers.Results:1 d and 3 d after surgery, serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of both groups were higher than those before surgery while bone formation markers BGP, BALP, PINP and OPG contents were lower than those before surgery;serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of MIPO group were lower than those of ORFI group while bone formation markers BGP, BALP, PINP and OPG contents were higher than those of ORFI group.Conclusion: Compared with ORIF, MIPO for middle humeral shaft fractures can reduce stress response degree and improve bone metabolism.
文摘Background： Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties ofanteromedial, anterolateral, and posterior plating for humeral shaft fractures. Methods： A distal third humeral shaft fracture model was constructed using fourth-generation sawbones （#3404, composite bone）. A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups： A, B, and C （n = 8 in each group） for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior （AP） and mediolateral （ML） directions and horizontal torsional destructive tests. Results： In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C （P 〈 0.05）. In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 ram, 0.13 ram, and 0.20 mm. Group B was smaller than Group C （P 〈 0.05）. In ML lbur-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 ram, and 0.17 ram. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05. and 16.83 N·m, respectively. Conclusions： Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group. We can suggest that anteromedial plating is a clinically safe and effective way for humeral shaft fractures.
文摘Background： Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. Methods： This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Results： Out of 78 patients, 69 patients underwent union in 90-150 days with a mean of I 10.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing joint movements and implant thilure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. ConcLusions： The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation ofosteoporotic and pathologic fractures.
文摘目的:探讨两种微创钢板内固定术(minimally invasive plate osteosynthesis,MIPO)治疗肱骨干近端骨折的临床效果。方法:选取2020年6月—2022年6月瓮安县人民医院收治的82例肱骨干近端骨折患者为研究对象。按随机数表法将患者分为两组,各41例。对照组行肱骨外侧入路MIPO术治疗,观察组行螺旋MIPO术治疗。比较两组手术情况、疼痛评分、肩关节功能、肩关节活动度及并发症发生情况。结果:观察组手术时间较对照组长,骨折愈合时间较对照组早,差异有统计学意义(P<0.05)。两组术后1 d、3 d、7 d的视觉模拟评分法(visual analogue scale,VAS)评分相比,差异无统计学意义(P>0.05)。两组术后Constant肩关节评分、美国肩与肘外科协会评分系统(American Shoulder and Elbow Surgeon'form,ASES)评分、美国加州大学肩关节评分系统(the University of California at Los Angeles shoulder rating scale,UCLA)评分高于术前,差异有统计学意义(P<0.05);两组术后Constant肩关节评分、ASES评分、UCLA评分相比,差异无统计学意义(P>0.05)。两组术后肩关节前屈、外旋活动度均高于术前,差异有统计学意义(P<0.05);两组术后肩关节前屈、外旋活动度相比,差异无统计学意义(P>0.05)。观察组并发症发生率较对照组低,差异有统计学意义(P<0.05)。结论:两种MIPO治疗肱骨干近端骨折均可取得较好效果,可加快肩关节功能恢复,而螺旋MIPO术骨折愈合更快,术后并发症更少。
