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Aim of the work — to study the shape and echogenic state of tissues in the bone fracture zone after a shaft fracture by ultrasonography and follow its relationships with the newly formed bone regenerate on X-rays. Materials and methods. Ultrasonographic examination was performed in 25 patients with shaft fracture of the humerus (13), crus (4), hip (8) on days 2–21 after the trauma using Toshiba Aplio-500 sonograph with linear detector of 5–12 Hz. Results. The main phenomenon, which was detected, was the presence of an anechogenic fusiform zone near broken bone fragments. It was visualized in the majority of examined patients, and we called it the fibrin-blood clot zone. A comparison of the size and shape of the fibrin-blood clot zone with the corresponding parameters of the newly formed periosteal bone regenerate was performed in 8 patients with humerus fracture. Ultrasonography in video recording mode allowed us to obtain information on the volumetric deformation of the fibrin-blood clot associated with the displacement of bone fragments in the process of functional loads. For example, in case of isometric tensions of the shoulder muscles, dislocations of broken bone fragments occurred, which were simultaneously accompanied by the change in the shape of the external contour of the fibrin-blood clot. Conclusions. Ultrasonography allows to evaluate the shape and size of the hematoma or fibrin-blood clot, which is in the state of forming, in the bone fracture zone, as well as to establish the character of its deformation in real time with loading. As a rule, the external contour of a fibrin-blood clot has an arch-like shape, which separates it from surrounding periosteum and muscles. A fact was confirmed that a hematoma and a fibrin-blood clot had an anechogenic structure during the first week after trauma, while echogenic inclusions appeared after the indicated time and more often in the peripheral zone. The shape and size of a fibrin-blood clot are close to the corresponding parameters of a periosteal bone regenerate. It gives ground to think that fibrin is a specific environment, on which a new bone is formed.

Introduction: Humeral shaft fracture is one of the common injuries encountered in orthopedic surgery accounting for 1% - 5% of all fractures. Although nonoperative treatment of humeral shaft fracture is associated with satisfying clinical and functional outcomes in most cases, usually results in varus deformity and limitation of shoulder and elbow motion in some patients. Thus, orthopedic surgeons prefer operative management due to early return to function and low compliance of the patients. Materials and Methods: 29 patients with diaphyseal fractures of the humerus treated with MIPO between January 2015 and June 2016 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 2 and 3 open fractures were excluded from the study. All patients having diaphyseal humerus fracture were treated with closed indirect reduction and plate fixation 4.5 dynamic compression plate using the MIPO technique. The surgery time, and time for union was noted. The shoulder and elbow function were assessed using the UCLA shoulder and Mayo elbow performance scores, respectively in follow up examination. Results: Of the 32 patients in the study, 16 were males and 13 were females. The mean age was 34.5 years (Range: 18-58 years). Twenty of the twenty nine patients had the dominant side fractured. We had six cases of C1 and A2 type; three cases of A1, B2 and C3 type; four cases of B1 type; two cases of C3 type; and one case of A3 and C2 type of fracture. The mean surgical time was 93.1 minutes (range: 70–120 minutes). The mean radiological fracture union time was 13.1 weeks (range: 10–18 weeks). Shoulder function was excellent in 24 cases (82.7%) and good in remaining 5 cases (17.3%) on the UCLA score. Elbow function was excellent in 25 cases (86.2%) and good in 4 cases (13.8%) on mayo elbow performance score. 2 patients developed radial nerve palsy and translation was present in 4 patients. Conclusion: In diaphyseal humerus fracture, MIPO gives good functional and cosmetic result and this should be considered as one of the good option in treatment of diaphyseal humerus fracture.

Background: Proximal humerus fractures account for nearly 6-10% and are on a rise. The management of this is controversial and is challenging task. There is a significant heterogeneity among the studies in describing the best surgical procedure in proximal humerus fracture. The objective of the study is to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures.Methods: A two-year prospective study was conducted after getting ethical approval at Narayana Medical College on cases admitted with proximal humerus fractures as per the inclusion criteria based on Neer’s classification. Radiological evaluation was done, and surgery was performed. Postoperative follow-up was done at 1st, 4th, 8th and 14th week and outcome were evaluated for each case based on Neer’s shoulder score.Results: 30 cases were included with a mean age of 48.2 years. Road traffic injury was common cause of fracture. Of the total 30 cases, 23 cases had excellent results, 4 cases were satisfactory, 2 cases were unsatisfactory, and one case had a failure. The mean scores observed on Neer’s score was pain (33.5 units), Function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units).Conclusions: Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures. Proper patient selection and thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery and good functional outcome.

Introduction: The humerus diaphyseal fractures account for 3% all bone fractures. Humerus diaphyseal fractures occurs in young adults because of high velocity injuries like road traffic accidents, fall from height, assaults and heavy machinery injuries, humerus diaphyseal fractures occurs in old age patients because of simple falls due to osteoporotic bones. Methods: A retrospective review was conducted of patients with humerus diaphyseal fractures. In all 26 patients were enrolled in the study, of which 13(50%) were treated with anterolateral approaches and the 13(50%) with posterior approaches. In this study we treated diaphyseal humerus fractures with open reduction and internal fixation by two different approaches, anterolateral and posterior, and compared results and functional outcome. Results: Out of all the 26 patients with diaphyseal humerus fracture 13 patients were operated with open reduction and internal fixation by plate osteosynthesis by anterolateral approach 10(38.46%) patients had excellent result, 1(3.84%) patient had good result and 3(11.53%) patients had poor result. And Out of all the 26 patients with diaphyseal humerus fracture 13 patients operated with posterior approach 9(34.61%) patients had excellent result, 4(15.38%) patients had good result and none had poor result. Conclusion: in our study we conclude that both approaches are equally effective for diaphyseal humerus fractures treatment in terms of fracture union, functional outcome and complications. Posterior approach to shaft humerus fracture is beneficial because with mobilization of radial nerve 76% of humerus shaft is exposed. In preoperative radial nerve palsy with diaphyseal shaft fractures posterior approach is better choice for nerve exploration. And anterolateral approach is better option for upper third and middle third diaphyseal humerus fractures and posterior approach is better option for distal third diaphyseal humerus fractures

Objective Arm wrestling is common sport amongst amateur enthusiasts. Multiple injuries are described as a result of the sport. The authors present a narrative review of the common injuries associated with the sport. Design Systematic review with a critical appraisal of the literature and a narrative review of the injuries associated with arm wrestling. Data sources Seven electronic databases were systematically searched using medical subject headings (MeSH) terms as follows. Arm wrestling, Indian Wrestling, Fractures, Injury, Ligament Injury with Boolean search terms “AND”. An extensive review of orthopaedic textbooks was also performed. Eligibility criteria for selecting studies Inclusion criteria were publications which included patients who suffered bony or soft tissue injuries as a result of arm wrestling published in English language. Results A total of 152 patients was seen across all studies. Spiral fractures of the distal third of the humerus are by far the most common injury reported in the setting of arm wrestling. The humerus fails due torsional and bending stresses. 23% were complicated by medial butterfly fragment and the incidence of radial nerve palsy was 23%. Fracture patterns differ in the skeletally immature arm wrestler, who show an increased incidence of medial humeral epicondyle fractures. We also report on the atypical fracture and soft tissue injury patterns that present.

Aim:Most of the childhood elbow area fractures constitute supracondylar humerus fractures. The treatment approach in Gartland type II fractures is controversial. The purpose of our study was to compare the effectiveness of cast and splint in conservative treatment of type II supracondylar humerus fractures.Methods:Sixty-nine pediatric patients admitted to our clinic due to gartland type II supracondylar humerus fractures between 2015 and 2020 were retrospectively evaluated. Closed reduction upper-elbow cast was applied to 26 patients, and closed reduction upperelbow splint treatment was applied to 43 patients. Radiological results of the patients were compared.Results:The mean age of the patients participating in the study was 4.86±2.61. Forty-two of 69 patients were male and 27 were female. Neurovascular deficit and compartment syndrome were not observed in any of the patients. When compared radiologically, no significant difference was found between the two groups.Conclusion:Type II supracondylar humerus fractures, where conservative treatment is planned, the upper elbow casting or splint selected for immobilization shows similar effectiveness in protecting reduction.

Impending and complete pathologic fractures often necessitate surgical fixation. Traditional orthopedic implants are commonly used, achieving clinically acceptable outcomes, but their metallic composition can impair radiographic evaluation and affect radiation treatments. Recognition of these concerns led to the development of radiolucent implants such as the minimally invasive Photodynamic Bone Stabilization System (PBSS; IlluminOss Medical Inc), featuring a light cured polymer contained within an inflatable balloon catheter. Two participating hospitals in one health care system reviewed cases using the PBSS implant. Twenty-five patients with 29 impending or pathologic fractures in the proximal radius or humerus from metastatic carcinoma, myeloma, lymphoma, and melanoma were identified. Clinical charts and imaging were reviewed to determine the status of the implant at final follow-up as well as complications. For analysis, a chi-square test was used for nominal variables and a t test was used for continuous variables. Eleven of the 25 patients were alive with disease at the time of analysis. Eight of 29 (27.5%) implants failed. Five of 25 (20%) patients required repeat surgery due to complications, including 3 revision open reduction and internal fixations, 1 open reduction and internal fixation for a periprosthetic fracture, and 1 screw removal. Five of the 9 cases (56%) ( P =.03) with lesions in the distal humeral shaft had breakage of the implant by final follow-up, compared with 3 of 20 cases (15%) ( P =.03) elsewhere in the humerus; no failures were seen in the radius. One of 4 patients (25%) also had failure in the surgical neck, although this did not reach significance. Five patients were noted to have progression of disease on follow-up radiographs, with 4 failures in patients with progression. The PBSS implants potentially allow improved surveillance of fracture healing and tumor recurrence along with decreased scattering of radiation during treatment. Unfortunately, there may be a higher rate of mechanical failures, particularly for lesions involving the distal humerus. This may be due to decreased cross-sectional area of the implant in this region as compared with the metaphyseal and proximal regions. Caution should be exercised when treating distal humeral pathologic fractures with large lytic lesions where the underlying disease process is not well controlled. [ Orthopedics . 2021;44(3):154–159.]

Background: The radial nerve arises from posterior cord of brachial plexus and descends distally to spiral groove, our aim is to study upper and lower margins of groove with respect of bony landmark like posterolateral aspect of Acromian process, medial and lateral epicondyle of humerus, which helps to identify radial nerve during humerus fracture fixation surgery and hence will reduce iatrogenic radial nerve injury.Methods: Twenty formalin preserved cadaveric upper limbs obtained from anatomy department of Government medial collage, Surat. Dissection done, Radial nerve isolated from low triangular space to lateral inter muscular septum and various measurements done for each specimen.Result: Without sex or age differentiation the results of this study are: The mean humeral length was 30.6 ± 1.86 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.3±1.48 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.49±1.46 cm. The mean length of radial nerve groove/spiral groove was 4.29±1.28 cm.Conclusion: Radial nerve is at the risk of injury with fracture & fixation in two areas. First along the spiral groove & second along the lateral aspect of humerus in distal third from proximal to lateral epicondyle to level of proximal aspect of metaphyseal flare. Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and zone of danger of humerus provide more safety during surgical interference of humerus. To do this, radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.

Fractures of surgical neck of the humerus represent 25% of the proximal part of humerus. Neer described three types of fracture of the surgical neck: angled, translated/separated and comminuted. Proximal humeral nail and PHILOS plate fixation for the surgical neck of humeral fractures offers good anatomic fracture reduction and stable primary fixation to ensure rapid fracture healing and imme­diate post-operative functional therapy without prolonged immobilization. Objective: To assess and compare the functional outcome and the fracture union of surgical neck of humerus fractures using proximal humeral nail and PHILOS plate. Material and Method: Prospective Comparative study was conducted at Bapuji and Chigateri General hospital attached to JJM Medical college, Davangere for a period of two years from July2018 to July 2020.60 adult patients with surgical neck of humerus fractures who were willing for surgery were admitted during the period of study and followed up for 12 months. Result: In our study most patients were Female (60%) out of 60 patient. The mean age being 58 years in Group1 and 47.66 years in Group 2. Most of the case were road traffic accident comprising of 65% in Group 1 and self fall 63% in Group 2. In this study,70% of the patients presented with 2-part fracture, 30% with 3-part fracture in Group 1 and 50% of each fracture pattern in Group 2. In this study, according to Neer’s score of patients had excellent 9(30%), satisfactory outcome 17(56.66%), and unsatisfactory outcome 4(13.33%) in Group 1 patients and, excellent result in 6(20%) cases, 20 cases (66.66%) had satisfactory outcome and unsatisfactory outcome 4(13.33%) in Group 2. Conclusion: Surgical neck of humerus treated with PHN offers minimally invasive, cosmetically acceptable scar, stable and axial fixation with minimal soft tissue damage, early mobilization, where as in PHILOS provide rigid and stable fixation in most of communited fractures.

Introduction: Intramedullary nail fixation has gained popularity and interest for the treatment of operative proximal humeral fractures. A diaphyseal fracture of the humerus is a common event accounting of approximately 3-5% of all fracture. Hence the present study was conducted with the aim to check the efficacy of interlocking nails in the treatment of diaphyseal fracture of humerus in adults. Materials and Methods: A total of 40 patients who satisfied the criteria were included in the study. All the patients were followed up at monthly interval for the first 3 months later at 2 monthly intervals till fracture union and once in 6 months till the completion of study. They were examined in details clinically and special stress was laid on shoulder and elbow range of movements and subjective complaints. Results: The overall results were analysed at the end of the study. The excellent result was obtained in the 24 patients, good result was obtain in 12 patients and poor result was found in 4 patients. Along the humerus fracture, there were 10 patients who had associated fracture. Discussion and Conclusion: Compared to other surgical modalities, closed intramedullary interlocking nailing is the least invasive surgical technique and has got least chance of post-operative infection and also reduces the hospital stay. Excellent results were seen in patients with associated injuries when humeral diaphyseal fractures were fixed with intramedullary interlocking nail as shown in the reduction in operative time and early rehabilitation. The advantages of intramedullary nailing are minimal surgical exposure, better biological fixation, and minimal disturbances of soft tissues and early mobilization of neighbouring joints.

Intracondylar T-type fractures of distal humerus represent a rare condition in paediatric population with unknown incidence since the literature is limited to case reports or case series. The main purpose of this article is to provide a comprehensive review of the current literature about the incidence and diagnostic modalities, as well as to evaluate all treatment options with results and complications. Review of the literature identified nine institutional reports in the period between 1984 and 2015, involving a total of 135 children and adolescents. Treatment options were open reduction with internal fixation and closed reduction in 118 and 17 cases, respectively. Open reduction was performed by different surgical approaches: triceps-sliding, triceps-splitting and olecranon osteotomy. Reported follow-up ranged from ten to 49 months. Outcomes were estimated by various tests, which are mainly based on range of motion. Patients younger than ten years generally had a better range of motion then older patients. Transient neuropathy and elbow stiffness were the most common complications, reported in 16.3% and 9.6% of cases, respectively. Despite the small number of reported clinical series, it is widely accepted that this fracture should be treated by open reduction with internal fixation to reduce and stabilise the displaced intra-articular fragments and to achieve anatomical congruity of the joint and integrity of medial and lateral columns.

Objectives This study aims to investigate whether complications related to distal locking can be prevented with InSafeLOCK® nail in the treatment of humeral shaft fractures. Patients and methods Hospital records of 31 patients (15 males, 16 females; mean age 54.4±10.1 years; range, 20 to 86 years) treated with InSafeLOCK® nail for humeral shaft fractures were investigated retrospectively between February 2016 and January 2019. Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification was used to determine the type of fracture. During the implementation, the elapsed time for distal locking was investigated. Complications encountered during both implementation and postoperative follow-up were investigated. Results Fourteen of the fractures were type A, 12 were type B, and five were type C. The mean follow-up time was 18.2 (range, 6 to 30.5) months. The mean duration for distal locking was 2.1 (range, 1.2 to 3.1) minutes. In one (3.2%) patient, cortical penetration occurred at the anterior cortex of the humerus at distal to the nail. In one patient, nail breakage occurred at the distal part of the nail. In one patient, rotational instability occurred due to screw loosening. Conclusion InSafeLOCK® humeral nail is safe when applied with the recommended technique. It can easily be applied without damaging the veins, nerves or other soft tissues around the elbow due to the internal distal locking feature; furthermore, there is no need to use fluoroscopy or targeting guide. Thus, it is possible to avoid complications that may occur during and after distal locking in conventional intramedullary nail implementations.

Background There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations. Methods A 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario. Results There was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon’s own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02). Conclusion While there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.

To compare the torsional failure strength of the humerus after subpectoral biceps tenodesis with an interference screw versus a unicortical button in a human cadaveric model.Thirteen matched pairs of fresh-frozen human cadaveric upper extremities were randomized to receive either 2.6 × 12 mm unicortical button or 6.25-mm interference screw subpectoral biceps tenodesis. After the procedure, the humeri were loaded into a materials testing machine. The humeri were loaded in external rotation with respect to the elbow at 1.0°/s until failure. Rotation angle to failure, failure torque, energy absorbed, and stiffness were compared by paired t-tests with alpha set at 0.05.Humeri that were fixed with unicortical buttons showed statistically significant higher rotation to failure (26.87 ± 5.83 vs 19.04 ± 3.86°, P.001), failure torque (54.11 ± 22.01 vs 44.95 ± 17.47 Nm, P.001), and energy absorbed (883.93 ± 582.28 vs 451.40 ± 216.19 Nm-Deg, P = .002) than humeri fixed with interference screws.In a cadaveric biomechanical model, at time 0, the use of a 2.7 × 12-mm unicortical button fixation in biceps tenodesis resulted in higher loads required to fracture the humerus when compared with a 6.25-mm interference screw fixation in a torsion model.This study demonstrates a significant biomechanical difference with regards to fracture of the humerus, between 2 commonly used fixations methods and implant sizes, interference screw, and unicortical button. The results of this study can aid surgeons in implant selection as well as help to improve patient education prior to surgery.

Aims To present a large series of concurrent upper limb and hip fracture in the elderly treated at a United Kingdom major trauma centre. Patients and methods Prospective data collection was performed for all elderly patients admitted to a single centre with hip fracture between January 2006 and November 2015. Comparative analysis of concurrent upper limb and hip fracture and an isolated hip fracture was performed. Results Study cohort included 307 patients that had sustained concurrent upper limb and hip fracture and 6887 with an isolated hip fracture. A concurrent upper limb fracture was associated with increased length of stay (21.7 vs. 18.8 days, p = 0.003) and decreased proportion of patients returning to their own home at discharge (39.2% vs. 49.4%, p = 0.001). No differences in age, Abbreviated Mental Test (AMT), Nottingham Hip Fracture Score (NHFS) and mortality were identified. However, concurrent wrist fracture 365-day mortality was lower than that of isolated hip fracture (20.9% vs 29.2%, p = 0.018). Concurrent humerus fracture was associated with increased inpatient death (13.7% vs 6.4%, p = 0.046) and 365-day mortality (34.7% vs 20.9%, p = 0.014) compared to concurrent wrist fracture. Surgical stabilisation of the concurrent upper limb fracture was performed in 90 wrist (52.3%) and 13 humerus (13.7%) cases. Operative management of the concurrent fracture did not yield significant differences in acute hospital length of stay or rehabilitation requirement. Cox regression analysis of 365-day survival data demonstrated that age, NHFS, AMT, gender and presence of a concurrent upper limb fracture independently influence 365-day mortality rate. Conclusion There are increased rehabilitation requirements for elderly patients with concurrent upper limb and hip fractures. There is a marked distinction in survivorship outcomes for patients sustaining concurrent wrist and concurrent humerus fractures. Clinical relevance Demonstrates increased rehabilitation requirements in concurrent upper limb and hip fracture in the elderly Highlights concurrent humerus fracture as a high risk group

Background: Anterior biological plating is one of the many options to treat diaphyseal humerus fractures in the adult age group. A clinical study was performed to evaluate outcomes over 6 months follow up period in 25 patients. Materials and Methods: The present study included 25 patients of the adult age group having diaphyseal humerus fracture treated with anterior biological plating between February 2018 to June 2019.Pathological, Malunited, and Gustilo Anderson open to grade 3 fractures were excluded from the study. Locking Compression Plating was done in all cases using the MIPO technique after closed indirect reduction. Functional outcome was assessedusing the DASH score at 6 months follow up. Results: The study consisted of 16 males and 9 females. The mean age was 42.36 years (range: 19-73 years).7 fractures out of 25 were 12A1, 2 were 12A2, 10 were 12A3,2 were 12B1 and 4 were 12B2 based on AO classification. Mean DASH score in the present study was 7.9 with 21 patients achieving excellent DASH Score and 4 patients achieving good DASH score with none of the patients having fair or poor DASH scores. Conclusion: ABP for mid-shaft humerus fractures is a safe and effective treatment modality yielding high rates of the union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior patient satisfaction.

Shoulder arthroplasty is becoming an increasingly standard procedure in the United States. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic humerus fractures is of great interest to orthopedic surgeons. Several periprosthetic humeral fracture classification systems take into consideration the fracture location and implant stability, but they do not address the type of bone defects or amount of bone available for revision surgery. The lack of description and guidance in the different varieties of humerus bone defects limits current classification system utility in cases with severe bone loss. There are previous case reports of revisions of periprosthetic humerus fractures with an allograft-prosthetic composite reverse total shoulder replacement. Different from previously reported cases, the case described in this article presented the treatment of a complex humerus fracture with loss of more than two-thirds of the patient’s native humerus. Due to the extensive humerus bone loss, we modified the surgical techniques previously published to allow for a successful surgery.

The purpose of this study is to determine if the radiographic humerus union measurement (RHUM) is predictive of union in humeral shaft fractures treated nonoperatively. All patients with long bone fracture nonunion presenting to a single surgeon were enrolled in a prospective registry. This registry was queried to identify patients with humeral shaft fractures treated nonoperatively and developed nonunion. The nonunion cohort was matched to a three to one gender- and age-matched control group that were treated nonoperatively for a humeral shaft fracture and achieved union. Two fellowship-trained orthopedic traumatologists blinded to eventual union scored radiographs obtained 12 weeks after injury using the RHUM. A binomial logistic regression determined the effect of the RHUM on the likelihood of developing union. Nine patients with humeral shaft fractures treated nonoperatively with radiographs 12 weeks after injury that developed nonunion were identified. These patients were matched to 27 controls. Logistic regression demonstrated the RHUM was a significant predictor of healing 12 weeks after humeral shaft fracture treated nonoperatively (p = 0.014, odds ratio 9.434, 95% CI for OR 1.586–56.098). All patients with RHUM below 7 went on to nonunion. All patients with RHUM above 8 healed. Three of seven patients (43%) with RHUM of 7 or 8 healed. The RHUM demonstrated an increased likelihood of achieving union 12 weeks after injury. Orthopedic surgeons can counsel patients that fractures with RHUM scores of 6 or below are in danger of developing nonunion and can target interventions appropriately.

Introduction Antegrade percutaneous intra-medullary nailing (IMN) has a poor reputation in the treatment of humerus fractures. The aim of the present study was to assess rotator cuff integrity and shoulder function after IMN in humerus fracture. Hypothesis Third-generation humeral nails (straight, small diameter, with locked screws) conserve rotator cuff tendon integrity and avoid the shoulder stiffness and pain incurred by 1st generation (large diameter, without self-blocking screw) and 2nd generation nails (curved, penetrating the supraspinatus insertion on the greater tuberosity). Methods Forty patients (26 female, 14 male; mean age, 60 years (range, 20-89 years)) with displaced humeral fracture (23 proximal humerus, 17 humeral shaft) underwent IMN using a 3rd generation nail (34 Aequalis™ (Tornier–Wright), 6 MultiLoc™ (Depuy-Synthes)). Mean clinical, radiologic and ultrasound follow-up was 8 months (range, 6-18 months); 22 patients agreed to postoperative CT scan. Results There were no revision surgeries for rotator cuff repair or secondary bone displacement. Mean Adjusted Constant Score (ACS) was 93 ± 22% and the Subjective Shoulder Value (SSV) 77 ± 18%. Elevation was 140 ± 36°, external rotation 48 ± 22° and internal rotation was to L3. Ultrasound found: 5 supraspinatus tendon lesions (12.5%) (2 full and 3 deep partial tears) without functional impact (ACS) 91% without vs. 107% with tear; (p = 0.12); 2 of the deep partial tears involved excessively lateral and high nail positioning. Eight patients (20%) had painful tendinopathy of the long head of the biceps (LHB) tendon associated with significantly impaired functional scores (ACS 65% vs. 100%; p Conclusion Supraspinatus tendon lesions following IMN with a 3rd-generation humeral nail were rare (12.5%) and asymptomatic; prevalence was not higher than in the general population in the literature (16%). LHB tendinopathy was frequent (20%) and symptomatic, and due to technical error in half of the cases. Level of evidence IV, retrospective study.

Introduction: Intercondylar fracture of distal humerus is one of the difficult fracture involving the humerus in adults. Intercondylar fracture distal humerus in adults are difficult to manage due to complex anatomy of elbow. We present a method of surgical treatment of intercondylar humerus fracture in adults by open reduction with JEES fixator and to evaluate functional outcome and associated complication with application of JESS fixator.Materials & Methods: It is Institutional based, prospective study carried out from June 2018 to May 2019.Twenty cases of intercondylar distal humerus fracture were reduced and fixed with K-wire and finally JESS was applied. Patient were follow up at 1week, 4weeks, 6weeks & 12weeks and clinically evaluated with Mayo’s elbow performance score. Results: According to AO classification 4 cases had C1 fractures, 14 cases had C2 fractures and and 2 cases had C3 fractures. 3 cases had open injury among which two were of C2 and 1 were C3 type. All cases were operated using paratricipital approach and average duration of JESS application was 7 week and mean follow up duration was 9 months. Irrespective of injury pattern 9(45%) cases showed excellent results, 7(35%) showed good results, 3(15%) cases showed fair results and 1(5%) case showed poor results.Discussion: The goal of intercondylar fracture management by JESS technique is to achieve early range of motion of anatomically align joint. Conclusion: This study shows comparatively good results using JESS fixator. This procedure is viable alternative option to ORIF dur to its simplicit, cost-effectiveness and easy implant removal on day care basis.

With the advent of good designs of nails, straight and angled in the arena of treatment for fractures from surgical neck of humerus to approximately 5 cm above the olecranon fossa, nailing is gaining popularity in recent literature. Many different nails are available in market with different proximal and distal locking configurations. Beach chair and supine are the main principle positions for antegrade humerus nailing. Beach chair or supine is the preferred position by many, but there is always difficulty in distal locking by free hand technique as it is difficult to locate the distal locking hole due to rounded smooth anatomy of anterior distal humerus and fear of neurovascular complications in both anteroposterior and latero-medial locking. The aim of this article is to demonstrate the utility of lateral position in ease of nailing all types of humerus fractures. The technique and illustrations below describe the positioning of patient, image intensifier and free hand postero-anterior distal locking without injury to neurovascular structures.

Background Posttraumatic shoulder stiffness remains a problem after proximal humerus fracture (PHF) despite good healing rates. The aim of this pilot study was to determine whether the implant material and overlying soft tissue have an effect on shoulder range of motion (ROM) before and after implant removal (IR). Methods 16 patients (mean age 55.2 ± 15.3 (SD) years; 62.5% female) were included who underwent operative treatment with locking plates of either carbon fiber reinforced Polyetheretherketone (PEEK) (PEEKPower® humeral fracture plate, Arthrex, Naples, Florida, USA, n = 8) or titanium alloy (Ti) (Philos®, DePuy Synthes, Johnson & Johnson Medical, Raynham, Massachusetts, USA, n = 8) for PHF. All patients presented with a limited ROM and persistent pain in everyday life after the fracture had healed, whereupon IR was indicated. ROM before and after IR were compared as well as the Constant Score (CS) and the CS compared to the contralateral shoulder (%CS) 1 year after IR. Results In group PEEK, elevation was 116.3° ± 19.2° pre- and 129.4° ± 23.7° post-IR (p = 0.027). External rotation was 35.0° ± 7.6° pre- and 50.6° ± 21.8° post-IR (p = 0.041). External rotation with the humerus abducted 90° was 38.8° ± 18.1° pre- and 52.5° ± 25.5° post-IR (p = 0.024). In group Ti, elevation was 110.0° ± 34.6° pre- and 133.8° ± 31.1° post-IR (p = 0.011). External rotation with the humerus at rest was 33.8° ± 23.1° pre- and 48.8° ± 18.7° post-IR (p = 0.048). External rotation with the humerus abducted 90° was 40.0° ± 31.6° pre- and 52.5° ± 22.5° post-IR (p = 0.011). Comparison of the two implant materials showed no significant difference. The overall CS was 90.3 ± 8.8, the %CS was 91.8% ± 14.7%. Conclusion There was no significant difference in ROM, CS and %CS with respect to plate materials, although lower cell adhesion is reported for the hydrophobic PEEK. However, all patients showed improved functional outcomes after IR in this pilot study. In patients with shoulder stiffness following locked plating for PHF, implants should be removed and open arthrolysis should be performed, independently from the hardware material. Level of evidence II

BACKGROUND: Supracondylar humerus fractures are the most common form of elbow fracture in children and adolescents. At present, treatment planning is based on the Gartland classification. Reduction and percutaneous pinning are done for Gartland type III fractures. In cases where closed reduction is unsuccessful, the procedure is converted to open reduction. However, there is no consensus on which patients are more likely to require conversion to open reduction. The aim of this study was to investigate the effect of fracture location on the rate of conversion to open reduction and clinical outcomes. METHODS: A total of 112 patients who underwent early surgery for Gartland type III supracondylar humerus fracture between August 2011 and August 2017 were evaluated. The patients’ age, sex, facture location, post-operative loss of reduction, and complications were noted. The fractures were classified according to fracture level relative to isthmus (high level) or at/below the isthmus (low level). Closed reduction was initially preferred. Open reduction with percutaneous pinning was performed, when necessary. Flynn’s criteria were used to evaluate elbow motion after treatment. RESULTS: Mean follow-up time was 39 months (16–62 months). The mean age of the patients was 6.4±2 years (1.4–12 years). Thirty-nine of the patients were female, 73 were male; 32 fractures were in the dominant arm, 80 were in the non-dominant arm. Ninety of the fractures were classified as high level (proximal) and 22 as low level (distal). Patients with low-level fractures were significantly younger (p0.05). CONCLUSION: The Gartland classification provides important guidance for the treatment of supracondylar humerus fractures, but may have limitations. Our results suggest that revising the classification by incorporating fracture location may be more beneficial for pre-operative planning. © 2022, Turkish Association of Trauma and Emergency Surgery. All rights reserved.

Highlights • Hydatid bone disease is caused by the Echinococcus granulosus worm. Osseous involvement accounts for 0.5% to 4% of cases in humans. • No reports of hydatid disease in the entire humerus have been found in the bibliography. • There is no consensus as regards the medical treatment of hydatidosis in the humerus. • The affections of the entire humerus and the recurrences present a challenge of treatment for the reconstruction and rescue of the limb. • We report a case of salvatage limb with a total humerus endophrostesis with 2 years of follow up., Introduction Hydatid bone disease is caused by the Echinococcus granulosus worm. The location of the disease in the humerus is infrequent. No reports of hydatid disease in the entire humerus have been found in the bibliography. We present one case of primary hydatid bone disease affecting the entire humerus, which was treated with radical resection and total endoprosthesis of the humerus. Case A 24-year-old patient presented with a diaphyseal humerus fracture. The x-rays and MRI showed an oblique fracture and heterogeneous osteolytic and multiloculated images along the entire humerus. The biopsy resulted in hydatid cysts. Oncological resection of the humerus and total replacement of the same with a non-conventional prosthesis designed for the patient was performed. Conclusion Total humerus hydatidosis is infrequent, and there is scarce information about its treatment. The local resection plus graft and osteosynthesis conserving the bone has shown complications and recurrences. For healing, a radical procedure is necessary. Although functional results may be limited.

The ideal technique to measure medial epicondyle humerus fracture displacement minimizes radiation exposure while maximizing measurement accuracy and reliability. This study compares the radiation exposure and accuracy of displacement measurements of the four-view X-ray examination (XR), computed tomography (CT) and in-clinic cone-beam CT (CBCT). A cadaveric humerus underwent medial epicondyle osteotomy. The fragment was fixed to the humerus at clinically relevant displacements (6 to 18 mm). Dosimeters were placed around the distal humerus and simulating thyroid location. XR, CT and CBCT were performed at each displacement. Four pediatric orthopedists measured the maximum linear displacement on each XR and 3D reconstruction of the CT and CBCT images. Focal (elbow location) and thyroid radiation exposure was compared between modalities. Intra- and interclass correlation coefficients (ICC) for displacement measurements were determined. Mean focal radiation exposures for XR, CT and CBCT were 0.008, 2.061 and 0.478 rad, respectively (P = 0.001). Exposures 10 inches from the elbow for XR, CT and CBCT were 0.001, 0.066 and 0.010 rad, respectively (P = 0.006). At 12 inches, there was no significant difference in exposure between XR and CBCT ( P = 0.114). Intra- and interobserver reliabilities were excellent for all measures, except lateral x-ray. CBCT and CT had significantly less deviation from the actual displacement compared to XR ( P 0.05). In-office CBCT of the elbow exposes patients to significantly less radiation than conventional CT. All X-ray images (except lateral), CT and CBCT had equal reliability in evaluating medial epicondyle fractures, which contrasts with previous evidence.

Background and Aims Most amputation procedures at the shoulder joint, on patients suffering from pathological humerus fractures are performed under general anesthesia.Here we show a case of an American Society of Anesthesiologists classification (ASA) III patient, scheduled for amputation of the humerus, at the shoulder joint. Due to a high risk procedure under general anesthesia, we decided to apply interscalene and paravertebral blocks along with intravenous sedation. Methods A 55-year-old male, ASA III patient, was scheduled for amputation of his right humerus. The patient had a history of bladder cancer with multiple metastases on the lungs, lymph nodes and bones. He also suffered from a pathological fracture of left humerus, with presence of left-hand cellulitis. During preparation for surgery, an invasive blood pressure measurement was set up, while the interscalene and paravertebral spaces were identified using a nerve-stimulating needle and a linear ultrasound probe of 8 and 12 Hertz. An anesthetic solution of 0.5% levobupivacaine was applied at Thoracic (Th) 2 and Th3 levels (5 milliliters per level) and to the brachial plexus (20 milliliters). We used 1% lidocaine for skin infiltration and sedation was performed with a continuous infusion of 1% propofol. Results Sensory blockade occurred after 18 minutes and lasted for about 16 hours in the shoulder and 10 hours in the axilla region, with stable hemodynamic parameters and no perioperative complications. Conclusions Such precise administration of small doses of long-acting local anesthetic at multiple levels has resulted in a satisfactory anesthesia and analgesia without hemodynamic and respiratory complications.

Introduction: Proximal humerus fracture is the most common fracture of humerus consisting 45% of all humerus fracture and second most common fracture in upper extremity. Diagnosis and proper management of proximal humerus fracture is important as the shoulder joint needs a high demanding function for daily activities. Various treatment options available for proximal humerus fracture from conservative management, K wire fixation, ORIF and plating, hemiarthroplasty to Reverse Shoulder arthroplasty.Aims and Objective: Our study aimed to evaluate the one year follow up results of different treatment modalities in a perspective series of proximal humerus fracture and study complication, if any involved with these modalities and to find out the basis of selecting the mode of treatment of proximal humerus fracture to bring out the best functional outcome.Materials and Method: 40 patients with displaced proximal humerus fracture (3 part and 4 part) treated between September 2018 to August 2019 were included in this study. Out of 40 patients in our study 32 patients have 3 part and 8 patients have 4 part fracture. 33 patients (3 part-27, 4 part-6) treated with PHILOS plating. 3 patients (All 3 part) treated with K wire fixation. 2 patients (All 3 part) treated conservatively. 2 patients (All 4 part) treated by Reverse Shoulder Arthroplasty. The functional outcome has been assessed by Constant-Murley shoulder scoring system.Results: Out of 40 cases 10(25%) patients had excellent result, 21(52.5%) good, 8(20%) moderate and 1 (2.5%) patient show poor outcome. There are few complications in our study-Malunion (3 patients), nonunion (2 patients), Joint stiffness (1 patient), Instability (1 patient), Heterotropic Ossification (1 patient), AVN of humeral head (2 patients).Conclusion: From this study we found that PHILOS is an effective treatment for 3 part fracture and for 4 part fracture Reverse Shoulder Arthroplasty is appears to be better option.

This prospective cohort study was conducted from July 2013 to May 2019. The functional and radiological outcome in displaced, neglected fracture of lateral condyle of the humerus treated with open reduction and internal fixation (ORIF) with Kirschner wire was assessed. The sample size was 44 children aged between 2 to 15 years Milch type I and II displaced lateral condyle of humerus fracture, four weeks and older were included. Carrying angle and infection was assessed clinically. Union and elbow functions were evaluated radiologically using the Mayo elbow score. The mean age of the children was 6.82 ± 2.83 years. Fracture was Milch type I in 11 (25%), and type II in 33 (75%). Pre- and post-operatively, Mayo elbow score was 3.63 ± 0.57 and 1.56 ± 0.50, respectively. Good to excellent functional outcome, and union was observed in delayed presenting lateral condyle of humerus fractures. Key Words: Lateral condyle humerus, Children, Delayed presentation, Mayo elbow score.

A polytrauma patient with a life-threatening condition is a quite demanding situation due to special considerations regarding the time, the way, and the sequence of the necessary procedures. Elastic intramedullary nails (EIN) could be used under these conditions for adult patients with humeral fractures requiring fixation. Here we present a case of a multi-segmental closed humerus fracture in a polytrauma patient treated by EIN. The general condition of the patient and the need for multiple surgical procedures required the selection of a minimally invasive and time-saving fixation technique. The patient's follow-up was uneventful with complete healing of the humeral fracture; the functional scores results are excellent at five years post operatively. A review of the literature revealed limited published cases of humeral fractures (128 patients) treated by EIN, despite the fact that the results are quite encouraging. Based on our results and the current literature, we believe that EIN could become an effective treatment choice for multi-level humerus fractures, especially in damage control surgery.

Background Identification of the radial nerve is necessary during surgery of the humerus fracture to avoid injury to it. Iatrogenic nerve injury during humerus fracture surgery is a well-known complication. Prevention of this type of injuries would be of great value. Aim of this study is to reduce the chance of iatrogenic nerve injury by defining of a danger zone in the distal upper arm regarding the radial nerve in indian population. Methods Thirty six upper limbs of eighteen adult human formalin preserved cadavers (14 males & 4 females) were used in this study. The posterior aspect of the arm was dissected to expose the radial nerve from the triangular space to the point where the radial nerve pierced the lateral intermuscular septum. Systematic identification of radial nerve and multiple measurements were done for each specimen. Results The mean humeral length was 30.96 + 1.23 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.5 + 0.79 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.34 + 0.41 cm. The mean length of radial nerve groove/spiral groove was 4.3 + 0.75 cm. Conclusions Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and the zone of danger of the humerus provides more safety during the surgical interference of the humerus. To do this, the radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.