Treatment of diaphyseal fractures of the humerus

Abstract

Introduction: Humeral shaft fractures represent approximately 3% of all fractures and 20% of the humeral fractures. Treatment modalities have evolved greatly, however, fundamental management principles have remained the same over time. Currently the surgical techniques and treatment outcomes improved a lot. Despite numerous treatment techniques, plate osteosynthesis remains the gold standard for fixation of diaphyseal fractures of the humerus. Locked intramedullary rods have become very popular in recent decades due to the minimally invasive treatment trends. Thus today there are still controversies in the treatment tactics of diaphyseal fractures of the humerus. Objectives: Evaluation of treatment of patients with diaphyseal fractures of the humerus. Materials and methods: The study was conducted on a sample of 225 patients, between 01.01.2013-31.12.2015 in the Orthopaedics and Traumatology Clinic of IMSP IMU. Results: Of the 225 patients, surgery was performed on 68.4% of cases and 31.5% - conservative treatment. The surgical treatment used the following methods of osteosynthesis: ORIF the anterior-lateral approach -39.61%; ORIF through posterior approach - 35.06%; Closed intramedullary nailing - 22.72%; Extrafocal osteosynthesis with rod type apparatus - 2.59%. Preoperative radial nerve injury -11.82%. One patient had postoperative radial nerve injury. Radial nerve revision was performed 3 months after osteosynthesis. Following conservative treatment: The infection of soft tissue - 1.40%; nonunion - 4.22% cases. After open reduction and plate osteosynthesis: operative wound infection - 3.47%; nonunions - 2.60%. Conclusion: Conservative treatment so far is the method of choice of diaphyseal fractures of the humerus, but does not provide satisfactory reduction of bone fragments and no ability to prevent secondary movements. The contemporary “Surgicalization” trends have been obtaining satisfactory results in the treatment. The success rate depends not only on the tactics that have been chosen, but also of the strict compliance with indications and contraindications to treatment methods.